Where a person presents with a classic history associated with clearly recognisable symptoms and signs of a condition, a diagnosis can be confidently made with ease. However, clinical scenarios of the same disease frequently vary and insisting on an exact match before making the diagnosis may miss the diagnosis and therefore be considered a "sin of greed".[1] One example is of kidney cancer, which classically presents with flank pain, blood in urine and a mass felt in the abdomen; a triad of features which present in less than 10% of cases. In practice, all "essential" features are rarely present and a person may reveal just a few classic features, which is where the request for testing plays a role in confirming or ruling out the suspected diagnosis.[1]
In dermatology, every textbook feature of a lesion need not be present to make the diagnosis.[8] Likewise, in cardiology, the expectation to explain every change on an ECG to conclude a diagnosis may represent diagnostic greed.[9] Another example has been of lead poisoning, where toxicology results have failed to support the diagnosis despite other features of heavy metal poisoning being present.[10]
Arguments for the need, on occasion, to have diagnostic greed, have also been made. Where a diagnosis may have considerable impact, additional tests providing supporting evidence might be required, making diagnostic greed advantageous.[3]