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Objective Sounds Better Than Subjective: Is It? Issues of Validity, Relevance, and Cost in Diagnostic Testing

Spaeth, George L. MD*; Thomas, Ravi MBBS, MD, FRANZCO; Ekici, Feyzahan MD*

Asia-Pacific Journal of Ophthalmology: May/June 2014 - Volume 3 - Issue 3 - p 133–135
doi: 10.1097/APO.0000000000000062
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Abstract: There has been a push in medical diagnostics and treatment to move toward objective testing and away from subjective testing. However, it is not certain that the superiority of one over the other is as clear cut as is usually considered to be the case. This issue is raised because there are advantages and disadvantages to every testing modality. The important considerations are degree of validity, of relevance, and of ease of obtaining the test, regardless of the type of testing. When a clinical diagnosis is certain or virtually certain, there is no need to use a test for diagnostic purposes. There still might be a justification for testing, however, even in such situations. In most instances, meaningful interpretation of a test result requires clinical information. Such clinical information is, of course, subjective, but still necessary. The use of tests in the clinic has to be directed by the “subjective” clinical examination, else the results make no sense. Subjective is “subjective” and as such open to biased interpretation. “Objective tests” also are often open to as much bias and misinterpretation as are subjective evaluations; they can seduce us into a false sense of security. It is essential to remember that the need for clinical evaluation will remain, and that the quality of the clinical evaluation is what is most critical to appropriate evaluation of any test result.

From the *Glaucoma Research Center, Wills Eye Hospital, Philadelphia, PA; and †Queensland Eye Institute, South Brisbane, Queensland, Australia.

Received for publication March 8, 2014; accepted May 9, 2014.

The authors have no funding or conflicts of interest to declare.

Reprints: George L. Spaeth, MD, Wills Eye Hospital, 840 Walnut St, Suite 1110, Philadelphia, PA 19107. E-mail: gspaeth@willseye.org.

© 2014 by Asia Pacific Academy of Ophthalmology
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