Solving the Diagnostic Challenge: A Patient-Centered Approach
Solving the Diagnostic Challenge: A Patient-Centered Approach
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DOI：
10.1370/afm.2264
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发表时间：
2018-07-01
影响因子：
4.4
通讯作者：
Donner-Banzhoff, Norbert
中科院分区：
文献类型：
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作者：
Donner-Banzhoff, Norbert
对临床问题达成一致和有效的解释对患者和临床医生都很重要。目前关于临床医生如何得出诊断的理论，如阈值方法和假设演绎模型，在一般实践中不能准确地描述诊断过程。一般实践中的问题空间是如此之大，而每种疾病出现的先验概率是如此之小，以至于将诊断过程限制为测试临床医生可能性列表上的特定诊断是不现实的。在这里，讨论了关于患者和临床医生如何以特定的方式合作的新证据，特别是通过可以被称为归纳觅食的过程，这可能导致触发诊断例程的信息。导航诊断挑战和使用以患者为中心的咨询不是单独的任务，而是协同工作。
Arriving at an agreed-on and valid explanation for a clinical problem is important to patients as well as to clinicians. Current theories of how clinicians arrive at diagnoses, such as the threshold approach and the hypothetico-deductive model, do not accurately describe the diagnostic process in general practice. The problem space in general practice is so large and the prior probability of each disease being present is so small that it is not realistic to limit the diagnostic process to testing specific diagnoses on the clinician's list of possibilities. Here, new evidence is discussed about how patients and clinicians collaborate in specific ways, in particular, via a process that can be termed inductive foraging, which may lead to information that triggers a diagnostic routine. Navigating the diagnostic challenge and using patient-centered consulting are not separate tasks but rather synergistic.