Thinking about diagnostic thinking: a 30-year perspective
Thinking about diagnostic thinking: a 30-year perspective
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DOI：
10.1007/s10459-009-9184-0
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发表时间：
2009-09-01
影响因子：
4
通讯作者：
Elstein, Arthur S.
中科院分区：
文献类型：
--
作者：
Elstein, Arthur S.
本文有五个目的：（a）回顾《医学问题解决》（Medical Problem Solving）一书的科学背景和主要研究结果，（B）将这些结果与最近畅销的案例研究中的一些结果进行比较;（c）总结对假设检验模型的批评，并说明这些批评如何导致更加强调临床经验和先验知识在诊断推理中的作用;（d）审查诊断推理中的一些常见错误;（e）审查减少诊断错误率的战略，包括以证据为基础的医学和系统审查，以增加个人知识、指南和临床算法、基于计算机的诊断决策支持系统和第二意见，以促进审议和更好的反馈。
This paper has five objectives: ( a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; ( c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; ( e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guidelines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback.