Abstract

As evidence-based medicine becomes established, the scope for individuality in the management of patients is decreasing. Not too long ago, reaching a diagnosis was often a challenge because of the absence of reliable diagnostic modalities. The accuracy, sensitivity, and specificity of many tests were so low that the results were often dismissed if they did not match the clinical diagnosis. Medicine at that time was much more an art than a science, and its practice was very individualistic. Seasoned diagnosticians frequently mesmerized their audience by their powers of observation and deductive reasoning. Grand Rounds were essentially a venue where astute diagnosticians exhibited their skills: they examined patients often with exaggerated theatrics, and then described the convoluted process by which they reached the final diagnosis, which often hinged on the detection of one or more obscure physical signs that most average clinicians missed.