When I started medical school more than 40 years ago, it was generally acknowledged by the clinical faculty that bedside diagnosis was a dying art, supplanted largely (even at that time) by a broad array of lab tests and medical imaging studies. It was occasionally remarked by them that the art of bedside diagnosis was alive and well in England where it was still held in high regard.
I published a previous note about the Biosite purchase by Beckman Coulter (see: Beckman Coulter to Acquire Biosite). An article that covered this story (see: Beckman to Acquire Test Maker Biosite) made reference to the Biosite pipeline of new lab tests as one of the reasons that Beckman Coulter viewed it as a worthy catch. Below is an excerpt from it (boldface emphasis mine):
The companies said they began working together four years ago on an indicator of congestive heart failure [BNP]. Biosite saw a need for the test to run on an automated system, such as those sold by Beckman. "We got together and found a way to convert that test to a format that would run on our installed base of automated platforms," Mr. Garrett said. The companies launched the test, B-type Natriuretic Peptide, or BNP, about three years ago. Beckman said it also hopes to benefit from Biosite's pipeline of new tests, covering acute coronary syndrome, sepsis, abdominal pain and other conditions. In a hospital, the cost of immunoassay tests can run as much as $20, compared with perhaps $1.50 or less for a routine cholesterol or glucose test.
In this article, my eye was immediately drawn to the reference to emerging lab tests for acute coronary syndrome, sepsis, and abdominal pain. It's clear to me that the next frontier for the clinical lab will be multiplexed syndromic diagnosis, as opposed to disease diagnosis. I am defining syndrome here as "a group of signs and symptoms that collectively define or characterize a disease or disorder -- signs are objective findings such as weakness, and symptoms are subjective findings." To this list of broad syndromes I would add other common ones such fever of unknown origin (FUO), chest pain, and syncopal (fainting) episodes. Multiplexed testing is defined as performing multiple lab test simultaneously using a single serum sample (see: All in one and one for all: multiplex testing).
The modus operandi for physicians in the future, I believe, faced with a patient with acute abdominal pain, for example, will be to order the "abdominal pain" test panel STAT. This panel will be composed of a set of biomarkers selected to diagnose the most common diseases and conditions that present with a so-called acute abdomen. I anticipate that the physician will then perform a rapid physical exam to assess the acuteness of the problem followed, in short order, by the ordering of a series of preliminary medical imaging studies. In such a rapid workup, the physical exam will be designed primarily for triage purposes and to select the most relevant lab and imaging studies rather than to arrive at a precise diagnosis for the patient.