Furthermore, it is possible that some of the patients
suffered from pneumonia despite a negative CXR. It has
been shown that, among inpatients, a radiographic
infiltrate can occur later according to progression of
the disease.[28] Some pneumonia patients might have
been missed among those with LRTI, as we know from
earlier studies that GPs make clinical judgements of
pneumonia in a minority of patients.[16,22,29] Another
limitation was that the physicians participated on a
voluntary basis and did not get extra time for the
consultations. This could have affected the number and/
or skewed the selection of recruited patients, as many
patients with suspected pneumonia were not included
in the study. Further, we do not know how many
patients rejected participation, or if they systematically
had more severe or milder symptoms than the
participants