The diagnostic process in outpatient endocrine care with special reference to screening. Further study of diagnostic...

A screening procedure based on physical examination alone was used in the outpatient unit of a department of endocrinology and metabolism. The volume effectiveness and efficiency of this diagnostic process was evaluated by studying the case-records and by mail questionnaire. The case-records of 296 patients admitted to the clinic during 1968 were analyzed. It was found that 103 of these patients were immediately referred back after a brief physical examination only. The pattern of diagnosis, its changes during the screening procedure, and the outpatient-investigation were also studied. 50% of the patients subjected to outpatient-investigation ended up with a new diagnosis. It was also possible to construct a diagnosis-specific cost estimate for outpatient-investigation, starting from a non-confident and arriving at a confident diagnosis. The distribution of these costs was very skew. The cost for the physician performing the screening was estimated to represent only 2.6% of the costs saved by the introduction of the screening.