Usefulness of Physical Examination in Detecting the Presence or Absence of Anemia

Arch Intern Med. 1990;150(9):1974. doi:10.1001/archinte.1990.00390200148035.
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To the Editor.—Nardone and coworkers1 have certainly gone to a lot of trouble to conclude that examination of the "nailbeds [is not] of value in assessing the presence or absence of anemia" and that one should revise one's "teaching of medical students with these findings in mind." Before giving up teaching a practice that is so simple and personally useful, 2 one would like a little more information from the authors.

  1. What about the Law of Chopin?3 (I can't play Chopin at all, but other people can play his music very well.) What was the diagnostic accuracy of the three examiners? (This assumes that there was no publication bias; ie, the examiners unconsciously wished to perform poorly so as to have something startling to report and so participate in the current frenzy of physical examination bashing.)

  2. We are given kappa values, which we are told are


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