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

OBJECTIVES

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.

PATIENTS AND

METHODS

Conjunctival inspection of 101 patients, subsequent correlation with haemoglobin concentration.

MAIN OUTCOME MEASURES: Number of correct and incorrect diagnoses of anaemia.

RESULTS

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.

CONCLUSIONS

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.