An analysis of paediatric diagnostic decision‐making: how should students be taught?

Summary. This study assesses the relative importance of history, examination and investigations in paediatric diagnosis, in the Paediatric Out‐patient Department of the Central Middlesex Hospital, London, by means of a questionnaire‐based record of 94 consecutive referrals. A diagnosis identical to the final diagnosis was made in 76% of referrals after taking a history. The general practitioner had proposed a diagnosis in 45% in the referral letter. Clinical examination changed the diagnosis in only 15% but increased diagnostic confidence in 33%. Ninety‐one per cent of cases were diagnosed without recourse to investigations. Forty‐two per cent of children referred had investigations performed. In the majority of paediatric cases the provisional diagnosis reached after taking a history was identical to that after examination or results of investigations were known. Although examination provided a final diagnosis in only 15% of all cases it played an important role in adding confidence in 33%. More educational effort should therefore be directed at clinical history‐taking skills and the subsequent purpose of examination.