Bibliographic record
Abstract
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.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.016 | 0.015 |
| Insufficient payload (model declined to judge) | 0.047 | 0.031 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".