To the Editor.—
The report by Poses et al1 analyzed the accuracy of physicians' estimates of the likelihood that a patient had streptococcal pharyngitis when first seen before throat culture results were available. They concluded that physicians overestimate the likelihood of streptococcal infection.The critical question, however, is not whether physicians assign an appropriate or inappropriate probability number to a clinical judgment, but whether their assessment leads to appropriate treatment being given and inappropriate treatment withheld. The physicians, as a group, have overestimated the likelihood of a positive throat culture (definition of streptococcal pharyngitis in the report) as 30%, whereas the observed rate was 5%. Nevertheless, their clinical assessment appears to have been sound. The 104 of 308 patients assessed as most likely having streptococcal pharyngitis and treated immediately with antibiotics were indeed twice as likely to be infected as were those 204 assessed as less likely and then
Lamm SH, Linn SA. Physicians' Accuracy for Diagnosing Sore Throats. JAMA. 1986;255(6):746–747. doi:10.1001/jama.1986.03370060059014
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