Richard A. Carleton, MD
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Carleton RA. Dichotomous Disservice. Ann Intern Med. 1997;127:1044. doi: 10.7326/0003-4819-127-11-199712010-00034
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Published: Ann Intern Med. 1997;127(11):1044.
Dr. Ferris correctly points out that physicians are humans and that “like all humans, often prefer to think dichotomously about phenomena that are clearly continua.” He also correctly points that many classifications require arbitrary distinctions. They do not, however, require artificial and arbitrary dichotomies. In the example of myocardial infarction, an understanding of the impact of that infarction on subsequent cardiac function and subsequent risk is better obtained by assessing the electrocardiogram, enzyme results, imaging results, and clinical presentation as continua rather than a simplistic “Q-wave/no Q-wave” system. Even, as Dr. Ferris suggests, a different dichotomy based on R-wave change would not be a suitable substitute.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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