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Stephen G. Reich
Arch Intern Med. 1983;143(1):181. doi:10.1001/archinte.1983.00350010193041.
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To the Editor.  —As an aficionado of medical history, I have noticed that there used to be a time when the approaches to the physical examination and to laboratory data were straightforward. The physician merely searched for physical findings, characteristic signs, and exacting diagnostic measurements—subsequently gathering the evidence and arriving at a diagnosis. A perusal of the June issue of the Archives (1982;142:1106-1107) reveals that we are on the verge of a new era in the art of diagnosis, namely, the "nondiagnostic diagnosis."In the issue mentioned, an article appears reporting four cases of Rocky Mountain spotless fever, and so begins the dilemma. No longer is it sufficient to search for existing physical findings; it is now equally important also to search for nonexisting physical findings.As a senior medical student, many confusions of the previous years are finally coming to light, but now that I must look for spots


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