‘Don't ask, don't tell’– the undesirable consequences of incidental test results in gastroenterology
‘Don't ask, don't tell’– the undesirable consequences of incidental test results in gastroenterology
复制标题
“不问，不说”——胃肠病学中偶然检测结果的不良后果
DOI：
10.1111/j.1365-2036.2004.02087.x
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发表时间：
2004
影响因子：
7.6
通讯作者：
A. Sonnenberg
中科院分区：
文献类型：
--
作者：
A. Sonnenberg
胃肠病学家经常在偶然的试验导致意外的阳性结果后进行内镜检查。偶然的检查结果应该被忽略还是自动进行内窥镜检查？本分析力求描述这种情况的共同模式，并解决其内在的困境。博弈论模型被用作制定一般管理策略的数学工具。三个临床场景作为例子来证明这种方法。该模型基于医生如何对他们所面临的各种结果进行排序。不同结果的排序列在一个决策矩阵中，该矩阵被转换为一个二乘二的非零有序博弈。所有附带测试结果的场景都是一种类似的游戏，最好由双方遵守相同的策略：“不做测试”和“不对它产生的任何测试结果做出反应”。这两种策略导致了非零博弈的纳什均衡，其中任何一方都不能通过选择不同的策略来进一步提高其收益。尽管这种均衡并没有给个体参与者提供最好的收益，但在经济和医疗条件限制下，它会给双方带来最好的总体结果。
A gastroenterologist is frequently approached to perform an endoscopic procedure after an incidental test has resulted in an unexpected positive finding. Should the incidental test result be ignored or automatically followed by an endoscopic procedure? The present analysis strives to characterize the common pattern of such scenarios and resolve their underlying dilemma. A model of game theory is used as a mathematical tool to develop general management strategies. Three clinical scenarios are used as examples to demonstrate this approach. The model is based on how doctors rank the various outcomes with which they are confronted by the incidental test results. The ranks of different outcomes are listed in a decision matrix that is converted into a two‐by‐two, non‐zero, ordinal game. All scenarios of incidental test results emerge as a similar type of game that is best played by both parties adhering to the same set of strategies: ‘Don't do the test’ and ‘don't respond to whatever test result it yields’. These two strategies lead to a Nash equilibrium for a non‐zero game, where neither party can improve its payoff any further by choosing a different strategy. Although the equilibrium does not provide the individual players with their best possible payoff, it yields the best overall outcome available to both parties given the economic and medical constraints of the situation.