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September 6, 1985

Delaying the Diagnosis of Disease

Author Affiliations

Harvard Medical School Boston

JAMA. 1985;254(9):1176. doi:10.1001/jama.1985.03360090066022

To the Editor.—  In an excellent COMMENTARY, Dr Spiro1 appropriately questions whether every complaint by a patient needs diagnostic studies before treatment. Having trained in a mecca of medical technology, until recently I would have responded with an emphatic yes! Fortunately, I recently had the opportunity to work at a rural hospital in Imo State, Nigeria. The diagnostic studies at this hospital are limited: complete blood cell counts, urinalysis, stool ova and parasite determinations, and simple radiographic examinations are available, but often prohibitively expensive for the impoverished population. Electrolyte determinations and other laboratory examinations, as well as electrocardiograms and bacteriologic cultures cannot be obtained. As a result, treatment without a definite diagnosis is commonplace. The patient with fever, malaise, and abdominal discomfort is not subjected to multiple cultures and gastrointestinal tract studies but, rather, treated for malaria. The patient with cough, fever, chest pain, and sputum production does not