The influence of experience and specialisation on the reliability of a common clinical sign

• Published in: Annals of the Royal College of Surgeons of England Vol. 82; no. 5; pp. 336 - 338
• Main Authors: Wallace, D E, McGreal, G T, O'Toole, G, Holloway, P, Wallace, M, McDermott, E W, Blake, J
• Format: Journal Article
• Language: English
• Published: England Royal College of Surgeons of England 01.09.2000
• Subjects: Anemia - complications; Anemia - diagnosis; Clinical Competence; Conjunctival Diseases - diagnosis; Conjunctival Diseases - etiology; Female; General Surgery; Humans; Ireland; Male; Medical Staff, Hospital; Observer Variation; Ophthalmology; Pallor - diagnosis; Pallor - etiology; Physical Examination - standards; Ireland
• ISSN: 0035-8843; 1478-7083

To explore the influence of experience and specialisation on clinical judgement by comparing accuracy in diagnosing anaemia between a consultant general surgeon, a consultant ophthalmologist and their registrars. Conjunctival inspection of 101 patients, subsequent correlation with haemoglobin concentration. Number of correct and incorrect diagnoses of anaemia. 54 patients were anaemic and 47 were not. Overall accuracy in diagnosing anaemia ranged from 0.61-0.69, sensitivity 0.52-0.65 and specificity 0.62-0.83. Agreements between pairs of examiners were 0.68-0.81, with kappa values of 0.36-0.60 when adjusted for chance agreement. Neither experience nor specialisation significantly influenced our ability to diagnose anaemia, based on conjunctival inspection. Without critical analysis of clinical signs, we are unaware of their diagnostic limitations.