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How well do internists diagnose common musculoskeletal complaints?
R A Parisek1, D F Battafarano, R L Marple
1General Medicine Service (R.A.P., R.L.M.), Rheumatology Service (D.F.B.), Brooke Army Medical Center, San Antonio, Texas; Rheumatology Service (M.C.), Wilford Hall Medical Center, San Antonio, Texas; Department of Medicine, Uniformed Services University of the Health Sciences (K.K.), Bethesda, Maryland.
Summary
Rheumatology training significantly improves diagnostic accuracy for musculoskeletal complaints in internal medicine. This enhanced diagnostic skill also leads to reduced evaluation costs for common conditions.
Area of Science:
- Internal Medicine
- Rheumatology
- Musculoskeletal Disorders
Background:
- Musculoskeletal complaints are frequent in outpatient internal medicine.
- Internal medicine residency programs often lack dedicated training time for musculoskeletal conditions.
Purpose of the Study:
- To assess if rheumatology training enhances diagnostic accuracy for common musculoskeletal syndromes.
- To determine if improved diagnostic accuracy correlates with reduced diagnostic costs.
Main Methods:
- Internal medicine residents, staff internists, and rheumatologists evaluated 15 musculoskeletal vignettes.
- Diagnostic accuracy, laboratory tests, radiographs, and consultations were analyzed.
- Costs of evaluation were calculated and compared with diagnostic accuracy and physician experience.
Main Results:
- Rheumatologists achieved 91% diagnostic accuracy, staff internists 75%, and residents 68%.
- Rheumatology training (>14 days) significantly improved diagnostic accuracy (p=0.0001).
- Accurate diagnoses were associated with lower evaluation costs.
Conclusions:
- Rheumatology training enhances the accuracy of diagnosing musculoskeletal syndromes in internists.
- Increased diagnostic accuracy through rheumatology training can lead to cost savings in patient evaluation.
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