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Colin Melville, MBChB, MMedEd
Keele University;
Keele, UK
Gøtzsche PC. Rational diagnosis and treatment: evidence-based clinical decision-making. Fourth edition. Chichester: J Wiley and Sons, 2007.
The book covers the application of scientific thinking to clinical medicine. Its origins pre-date "evidence-based medicine" as formalised by Sackett et al, and historical and philosophical links are made to the origins of scientific thinking and the Age of Enlightenment.
The structure of the book follows the traditional clinical encounter, from history-taking and clinical examination to establishing a diagnosis and using clinical investigations to the rational use of therapies and the individualisation of treatment.
Throughout the book, emphasis is on the precise use of terminology, including the derivation of new terms where old ones are felt to be confusing. For example, in the chapter on diagnosis, new terms of nosographic "true negative rate" instead of "specificity" and "true positive rate" instead of "sensitivity" are proposed. The book also takes a different tack on diagnostic tests, with tests being seen as situated within
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