Discussion about this post

User's avatar
Phil Shaffer, MD's avatar

This is some excellent, interesting, and valuable work. I am stunned you couldn't find a home for it in the literature. Doubly stunned when I see the trivial nature of 80% of the material I see in the refereed literature.

Expand full comment
Frank Harrell's avatar

In many ways, teaching of probabilistic diagnosis in medical schools focuses on an opportunity to teach Bayes' rule, sensitivity, specificity, and likelihood ratios. For many diseases the pre-test probability of disease is more important than the test result, and estimation of pre-test probability is de-emphasized. Decision making would be improved by teaching the logistic regression model instead, where multiple continuous test results can be easily handled and the pre-test variables get all the emphasis they deserve. We need to move past oversimplified diagnostic impact summaries such as sens, spec, LR and think multivariably. And keep in mind that LRs, more useful than sens and spec, are still oversimplifications that have turned continuous test outputs into binary all-or-nothing variables.

Expand full comment
11 more comments...

No posts