Dealing with uncertainty, risks, and tradeoffs in clinical decisions. A cognitive science approach.
Dealing with uncertainty, risks, and tradeoffs in clinical decisions. A cognitive science approach.
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处理临床决策中的不确定性、风险和权衡。
DOI：
10.7326/0003-4819-108-3-435
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发表时间：
1988
影响因子：
39.2
通讯作者：
J. P. Kassirer
中科院分区：
文献类型：
--
作者：
Alan J. Moskowitz;Benjamin Kuipers;J. P. Kassirer
为了生成关于医生如何做出困难的临床决定的假设，我们分析了专家临床医生在做出不确定诊断的测试或治疗决定时的“大声思考”行为的抄本。我们将临床医生的推理与对同一问题的决策分析进行了比较。专家们没有制定其决定的全球大纲，而是根据现有的和不完整的信息将一系列决定联系在一起。尽管有效和高效地解决问题，临床医生只使用数字术语作为可能性的符号表示，在选择备选方案时使用有限的信息，并排除了非常规策略--经验性疗法--可能产生相同结果的可能性。我们描述了认知问题解决策略和知识表征，它们允许人们在有限的处理资源的情况下做出成功的决定。同样的认知过程可能会导致在不确定情况下的决策过程中观察到的错误。
To generate hypotheses about how physicians make difficult clinical decisions, we analyzed transcripts of the "thinking aloud" behavior of expert clinicians making a testing or treatment decision with an uncertain diagnosis. We compared the clinicians' reasoning with a decision analysis of the same problem. The experts did not formulate a global outline of their decision, but chained together a sequence of decisions based on available and incomplete information. Despite effective and efficient problem solving, the clinicians used numeric terms only as symbolic representations of likelihood, used limited information in choosing among alternatives, and dismissed the possibility that a less conventional strategy, empiric therapy, might yield equivalent outcome. We describe cognitive problem-solving strategies and knowledge representations that permit persons to make successful decisions despite limited processing resources. The same cognitive procedures probably contribute to observed errors in decision-making under uncertainty.
影响因子：
5.9
作者：
BECK, JR;KASSIRER, JP;PAUKER, SG
通讯作者：
PAUKER, SG