Clinical Diagnosis—Is There Any Other Type?

Gurpreet Dhaliwal

doi:10.1001/jamainternmed.2020.3048

Invited Commentary

August 17, 2020

Clinical Diagnosis—Is There Any Other Type?

Gurpreet Dhaliwal, MD^1,2

Author Affiliations Article Information

¹Department of Medicine, University of California, San Francisco
²Medical Service, San Francisco Veterans Affairs Medical Center

JAMA Intern Med. 2020;180(10):1304-1305. doi:10.1001/jamainternmed.2020.3048

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In this issue of JAMA Internal Medicine, van der Geest et al¹ present a systematic review and meta-analysis of the diagnostic accuracy of symptoms, signs, and laboratory tests for giant cell arteritis (GCA). Their comprehensive review of 68 studies with 14 037 patients provides updated guidance for clinicians who assess the probability that a patient has GCA. This estimation drives decisions about temporal artery biopsy and glucocorticoid administration that include considerations of timing and logistics, patient comorbidities, coordination with consultants, and adverse effects of treatment. Giant cell arteritis is a disease that has no reference or “gold” standard test, yet once affixed to the record, it can set off a complicated diagnostic and therapeutic cascade.

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1 Comment for this article

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August 24, 2020

Interesting and Fun Article!

William Davis, M.D. | Clinical medicine

This is an interesting & fun article (thank you!). However, methinks it basically restates what’s been endlessly discussed (& fairly often agonized over) - i.e., that in the (very best) practice of medicine there’s both ‘science’ & ‘art.’

Of course we all hope for ‘Star Trek’ times when. as in the hands of Dr. Leonard H. "Bones" McCoy, a smartphone-like gadget can briefly and innocuously ‘scan’ a patient and tell us in detail, with pinpoint accuracy, all the diagnostic info we need. Indeed, in my lifetime with the advent of such things as CTs and MRIs and a proliferation of other absolutely marvelous diagnostic tools there have been quite a few diagnoses that have moved from the category of ‘clinical’ to the more substantive category of ‘hard data.’

Meanwhile however there will likely continue to be situations in which, by means of conscientious lifelong study, aptly putting the pieces of the puzzle together will demand and hinge upo the best possible amalgam of clinical skills (including consideration of such consultative assistance as may be required on a case-by-case basis).

Thanks very much again for this really fun and interesting article!

CONFLICT OF INTEREST: None Reported

Clinical Diagnosis—Is There Any Other Type?

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