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James F. Fries, MD

Arch Intern Med. 1970;126(4):647-651.

Abstract
A system of selective sequential questioning is presented by which meaningful symptom-complex subsets may be constructed. Generalized, the procedure results in a flow sheet applicable to differential diagnosis. An ideal subset is homogeneous with regard to clinical diagnosis; distance from the ideal is measured by tabulating the frequency with which a subset is associated with a particular diagnosis. Given sufficient patients, this tabulation expresses the "conditional probability" that a patient with a given symptom-complex subset has a particular disease. Applied to the diagnosis of arthritis, the system proved 96% accurate and was in some respects more consistent than clinical diagnosis. This system avoids the problem of the interdependence of variables and increases usefulness by presenting the tabulation of its previous experience with the subset for evaluation by the user.

Author Affiliations
Stanford, Calif

From the Immunology Division, Department of Medicine, Stanford (Calif) University School of Medicine.

Footnotes
Received for publication Nov 19, 1969; accepted April 23, 1970.

Reprint requests to Department of Medicine, Stanford University School of Medicine, Stanford, Calif 94305 (Dr. Fries).

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