Abstract

INTRODUCTION

This ‘How to do it’ series presents a paradox. The aim is simple–an expert advises a relative novice on the best approach to a particular problem, in this case the confirmation of a suspected diagnosis of myasthenia gravis. However, in reality the approaches of the expert and the novice are quite different. The expert subconsciously uses their enormous experience of the condition to make a gestalt diagnosis, and might then use one or two carefully chosen tests to provide laboratory confirmation, being familiar with the false-positive and false-negative implications of each test. The less experienced misinterprets the clinical picture, arranges inappropriate investigations, and is then caught out by false-positive findings. It is partly because of such considerations that patients increasingly demand access to specialist rather than general clinics. This paradox aside, the aim of this review is to offer some advice from the experienced to the less experienced,