The evolution and future of ACC/AHA clinical practice guidelines: A 30-year journey: A report of the American College of cardiology/American heart Association task force on practice guidelines

摘要

However, I am not writing with the wounded pride of a clinician to bemoan a gradual decline in my authority, but instead, with the intimate conviction that the indiscriminate use of instrumental diagnostics has a serious impact on health care quality and cost. It is disconcerting to see training cardiologists with an abundant knowledge of technical details showing embarrassment in the presence of a heart murmur or an extra cardiac sound, to the extent that he or she is unable to make a diagnosis based on clinical information derived from history and physical assessment. Cardiologists of this extraction, who developed strong technical skills during their training but kept themselves untangled from clinical dexterity, may feel uncomfortable when asked to handle clinical issues without the support of instrumental tests.