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Editorial

Clinical Correlation Is Suggested

Johnson, Ernest W. MD

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American Journal of Physical Medicine & Rehabilitation: November-December 1999 - Volume 78 - Issue 6 - p 503
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One of the tasks I enjoy is reviewing electro-diagnostic (EDX) reports of attendees at the many Continuing Medical Education courses we have sponsored during these past 35 years.

This sentence, "Clinical correlation is suggested," appears on many EDX reports, usually ending a discursive paragraph of electrodiagnostic prolix with no conclusions.

Is it a "CYA" or simply an admonition to the referring physician?

My belief, after seeing many reports with this phrase, is that it usually means that the electromyographer does not have a clue and is reluctant to say, "I do not know."

The EDX report is often incomplete, inappropriate, or irrelevant, and the electromyographer still wants to get his or her opinion on the record (maybe for extra $$?).

Isn't the EDX examination a consultation of electrodiagnostic medicine? If my thought is correct, then the EDX report should be a thoughtful evaluation and diagnostic opinion, never "clinical correlation is suggested."

This sentence is only a surrogate for ignorance or downright incompetence.

I am not surprised to see this caution appearing in reports that describe an EDX examination that is incomplete or not helpful to the referring physician. Equally as frequently, the EDX test is either not indicated or is an "add-on" to a consultation (often, also not useful).

Should an electromyographer ever write, "clinical correlation is suggested"?-probably only when the referral is from a nonmedical source (in my opinion). Is it insulting to tell the referring physician to "go back and examine the patient"-even if you think he or she should?

I have, on rare occasions, called the referring physician and suggested that there was no need for an EDX examination. An example is a 10-year-old girl who had a limp; a pediatrician had referred her. After a neuromuscular examination was performed to plan for the EDX test, I came to the conclusion that she had juvenile rheumatoid arthritis and that there was no need for an EDX examination.

There are instances when the electromyographer can introduce alternative diagnoses or suggest additional diagnostic procedures to clarify a difficult clinical problem, but to dump on the referring physician an affront such as "clinical correlation is suggested" approaches OUTRAGEOUS.

My overwhelming, but still considered, reaction to the reprehensible phrase "clinical correlation is suggested" is to find it sophistical-i.e., misleading at best and downright deceiving at worst.

Ernest W. Johnson, MD

Editor

© 1999 Lippincott Williams & Wilkins, Inc.