Diagnostic Authority/interrater reliability

[Guest guest]

, " Robert L. Felt " <bob@p...>

wrote:

If we can show that similarly trained clinicians examining a

similar patient population agree on the pattern labels more frequently

than

is likely by chance, (what is known technically as `inter-rater

reliability'), and that the therapeutic outcomes are as reliable as

the now-standard therapies, the diagnostic authority of Chinese medicine

 

would be at no practical disadvantage to many biomedical therapies

 

The crux of the problem is that we cannot demonstrate this kind of

interrater reliability in my experience. I have worked on thousands

of cases in cooperation with hundreds of student interns, dozens of

chinese clinical supervisors and numerous colleagues in group

practice settings. Agreement on dx and tx is the exception, not the

rule in

my experience. these differences extend right down to observations,

where one chinese professor calls a pulse slippery and tongue coat thin

white and another calls the pulse wiry and tongue coat peeled - on the

same

patient. So while in theory, interrater reliability may be possible,

I have not seen this in practice.

 

We can say this is due to poor education or lack of standards or too

much foundational diversity in our training, but how does that

explain this lack of interrater reliability amongst chinese trained TCM

doctors in American clinics? I won't speculate on why this is so right

now,

but only want to point out that if we attempt to use interrater

reliability as the basis for establishing the validity of TCM

patterns, we are in for a rude awakening. On one hand, I know I am not

the

only one who has had this clinical experience and on the other, I have

heard that interrater reliability is far better in china. What gives?

 

todd