> The right answer depends on many factors including the capabilities of your hospital [...] Absolutely ! I'll add that the physician himself is a kind of tes

> The right answer depends on many factors including the capabilities of your hospital [...] Absolutely ! I'll add that the physician himself is a kind of test, in the sense that his own sensitivity/specificity to diagnosing a disease can be calculated. It is well known -- and I'a argue it's a feature, not a bug --, that the exact same patients with the exact same symptoms will have a different work-up whether he's seen a GP, an emergency physician, or, say a heart surgeon. The reason is pretty simple: because disease prevalence is different in those three practices, the doctor has to order more or less tests to get the same predictive power. E.g., when every patient has heart disease, every ECG change is probably sign of disease, whereas when almost nobody has any heart problems, ECGs are pretty meaningless.