A few months ago in this column [ quoted my friend's desire to rewrite the medical textbooks. On page 273 Nick Summerton opens his review of medical history as diagnostic technology by asking whether it has become redundant. His own answer, perhaps predictably, is a negative. Not only is a good history essential if the expensive modern diagnostic technologies are going to work at alt, but he argues that we are now in a position to understand much better what different symptoms and signs really mean. There are surprises in store, for instance: 'In relation to the diagnosis of pneumonia in a patient with a cough, eliciting a history of sputum production merely affords an additional positive likelihood ratio of 1.3' (page 274). Our ignorance of the weight to be attached to common signs and symptoms is a major stumbling block at present.
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