Notice bibliographique
Résumé
Re: Haslam RH. Why perform a history and physical examination when we have magnetic resonance imaging? Paediatr Child Health 2010;15(8):495–496. To the Editor; Thank you Dr Haslam, I really mean it: THANK YOU! I have worked as a community paediatrician for 25 years and have taught family practice residents for almost as long. I cannot agree more with Dr Haslam. I was recently called to see a young nine-year-old girl who had come to our emergency room with abdominal pain. She was thought, by the emergency room doctor, to have “? Appendicitis” and the surgeon was consulted. By the time I was called to see her, she had spent approximately 8 h in the emergency room, and had gone through no less than one ultrasound of the abdomen and two (yes TWO) computed tomography scans of the pelvis. The diagnosis of benign acute gastroenteritis had not yet been made. No one had taken the time to examine her yet, no one had even put a hand on her abdomen to find out whether there was guarding of any sort, and no one had taken the time to ask about the four-year-old brother who had an episode of vomiting, diarrhea, dehydration and fever one week earlier. If someone had performed these basic steps, the diagnosis of rotavirus gastroenteritis would have been made very much earlier. The environment of overwork, the constant medical legal ‘Damocles sword’ coupled with the exponential multiplication of guidelines, clinical pathways and protocols have created an atmosphere of ‘dys-ownership’ of the patient. Consequently, extenuated physicians are, at times, more concerned about following the ever-changing most recent protocol so as not to be harassed by administrative measures, than they are about the actual well-being of the patient. I should add that the physicians involved in that case are my friends, and I know they are good physicians. The solution to this issue is to have less administration, less protocols, more legal ‘protection’ (which does not mean that one should not be penalized for negligence, but this is another topic) and a return of the ‘moral’ ownership of the patient to the caregivers. We must insist on teaching residents these extremely important basic steps in medicine: take a history and perform a good physical examination. Dr Frank Ford was right; it is still true today and will be true tomorrow: laboratory tests and x-rays are here to confirm the clinical impression – if they don't, they are wrong. If we do not have a clinical diagnosis before we order them, we won't have one after. Once again, thank you Dr Haslam.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,002 | 0,002 |
| Communication savante | 0,004 | 0,004 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,016 | 0,015 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,047 | 0,031 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».