16 Chapter 1 important outcomes, a series of essentials steps – such as treatment of a certain condition – should be taken. Testing in clinical practice Clinical decision-making with the use of a test or testing strategy is daily practice. Healthcare professionals may consider the use of tests after history taking and physical examination. Patients may also demand for tests for various reasons, such as family history of disease, concern about physical conditions, or the need for regular testing. Most patients have high expectations regarding the value of tests: they do not expect false positive or false negative test results and do believe that test results are reliable. In other words, test results would give them certainty about their health status and reassure them in case of test results in the normal range [36]. Testing is frequently used for diagnostic purposes. In clinical practice, the diagnostic process is an empirical iterative process [37]. It has inductive and deductive elements, based on Bayes’ theorem [38]. Bayes’ theorem, also known as Bayes’ rule, states that the a posteriori probability of an event (such as a disease or condition) is conditional and depends on the a priori probability of that event and test results. Taking medical history (anamnesis), conducting physical examination and routine medical testing (such as routine laboratory tests) are generally inductive processes for making a general diagnosis (‘rough selection’). Clinicians use signs and symptoms and combine them inductively to move in a diagnostic direction. This can be seen as hypothesis generation. In addition, specific tests (such as spirometry or a dementia test) can be conducted as part of deductive processes. These are targeted tests, intended to confirm or rule out a specific diagnosis. These can be seen as hypothesis testing. The entire diagnostic process in the clinical practice is called the hypothetico-deductive method [39-41]. The diagnostic process includes both sense (including clinical reasoning, understanding, experience and common sense) and science (including evidence, theory and testing) [42]. Clinical experience, which includes gut feelings (‘pluis/niet pluis’), is a crucial element of patient care during consultations [43]. Accordingly, tests serve as complementary tools in clinical practice. Testing in healthcare In this thesis, a test or testing refers to all healthcare related tests and testing strategies that are used for different purposes and roles [44]. Thus, this thesis extends beyond the use of tests for diagnostic purposes by healthcare providers in the consultation room to encompass the entire healthcare, including public health.
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