Acute febrile illness: Epidemiology versus clinical judgement

Abstract

Both epidemiology and clinical judgment are teachings by the father of medicine, the Greek physician. Hippocrates The term Epidemiology derives from the Greek: epi “upon/among” demos “people/district”, logos “study/disclosure”, so literally it means “the study of what is upon the people”. Hippocrates coined the terms endemic for diseases usually found in some places but not in others and epidemic for diseases that are seen at some times but not others. Clinical judgment is the application of information based on actual observation of a patient combined with subjective and objective data that lead to a conclusion; process by which the doctor decides on data to be collected, makes an interpretation of the data, arrives at a clinical diagnosis, and identifies appropriate management actions; this involves critical thinking, problem solving, and decision making. The knowledge of epidemiology is important to narrow down a differential diagnosis in a given situation. However, it should not result in tunnel vision. Furthermore, today epidemiological data together with the advancement of science seem to have shadowed or replaced the most valued history taking and examination taught by Hippocrates. For example, some infections have been overlooked in the middle of a known disease outbreak leading to extended morbidity by the former illness simply due to poor history taking and or examination. Similarly increasingly introduced epidemiology based sophisticated rapid diagnostic tools such as multi-test strips are likely to be misused, misinterpreted or wasted ignoring the value of systematic clinical approach in arriving at a diagnosis. At the same time, today infectious disease aetiologies are fast changing due to globalization, expansion of human travel, travel of bugs and hosts, expanding animal industry, and re-emergence of old bugs. Therefore in addition to having a good knowledge on local, regional and global epidemiology, an infectious disease physician today, should ensure a good clinical sense, broader thinking and an open mind in order to tackle an individual patient. This is the greatest challenge faced by an infectious disease physician compared to a physician attending to a well streamlined management plan of a non-communicable disease. This talk will be supported by case scenarios. © 2012 Elsevier Inc.