Jonathan P. Whitney, MD
To the Editor: As an office-based community internist, I believe that the conclusion in the article by Van Ness and Diehl (1) that liver biopsies are helpful in evaluating liver enzyme abnormalities has some flaws. The study's first problem is in how the patients were "referred" to the outpatient gastroenterology clinic at Bethesda Naval Hospital. These patients were apparently already sorted out by primary care physicians and, for one reason or another, were referred to a gastroenterologist for further evaluation. The decisions may have been based on symptoms that the patient presented with or signs that the physician detected during
Whitney JP. Liver Enzymes and Liver Biopsy. Ann Intern Med. 1990;112:311. doi: 10.7326/0003-4819-112-4-311_1
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Published: Ann Intern Med. 1990;112(4):311.
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