ABSTRACT
The iatrotropic problem itself might, perhaps, be a physical finding such as a swelling, a lump or a skin lesion rather than a specific symptom. The patient may even proffer a specific diagnostic concern such as shingles or impetigo. Rather than attempting to separate the wheat from the chaff, it seems that many clinicians have simply ditched the clinical examination. However, there is evidence that, when carefully conducted and focused, it can still provide a wealth of useful discriminant information. The medical history produces a post-history probability that can be adjusted further by the likelihood ratios arising from the clinical examination to produce a new probability of disease. However, it is important to re-emphasise that the post-examination probability is intimately dependent on the post-history probability. Reliability might be improved by training, possibly using a number of aids such as models, videos, CDs and even simulated and 'standardised' patients.
