A Universal Model of Diagnostic Reasoning
A Universal Model of Diagnostic Reasoning
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DOI：
10.1097/acm.0b013e3181ace703
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发表时间：
2009-08-01
影响因子：
7.4
通讯作者：
Croskerry, Pat
中科院分区：
文献类型：
--
作者：
Croskerry, Pat
临床判断是医生在医学上表现的一个关键方面。它是制定诊断必不可少的，也是有效和安全管理患者的关键。然而，总体诊断错误率仍然高得令人无法接受。在四十多年的研究中，已经采取了各种各样的方法，但对诊断决策的共识方法尚未出现。在过去的20年里，关于人类判断的心理学研究取得了重要进展。双过程理论已经成为主要的方法，它假设了两个决策系统，系统1（启发式的，直觉的）和系统2（系统的，分析的）。作者提出了一个示意图模型，该模型使用该理论来开发临床决策的通用方法。该模型的性质解释了许多观察到的医生表现特征。然而，作者警告说，并不是所有的医学推理和决策都能整齐地归入模型系统中的一个或另一个，即使它们提供了一个包含公认的不同方法的基本框架。他还强调了实际临床情况下决策的复杂性，迫切需要更多的研究来帮助临床医生获得更多的洞察力和对他们决策的理解。
Clinical judgment is a critical aspect of physician performance in medicine. It is essential in the formulation of a diagnosis and key to the effective and safe management of patients. Yet, the overall diagnostic error rate remains unacceptably high. In more than four decades of research, a variety of approaches have been taken, but a consensus approach toward diagnostic decision making has not emerged.In the last 20 years, important gains have been made in psychological research on human judgment. Dual-process theory has emerged as the predominant approach, positing two systems of decision making, System 1 (heuristic, intuitive) and System 2 (systematic, analytical). The author proposes a schematic model that uses the theory to develop a universal approach toward clinical decision making. Properties of the model explain many of the observed characteristics of physicians' performance. Yet the author cautions that not all medical reasoning and decision making falls neatly into one or the other of the model's systems, even though they provide a basic framework incorporating the recognized diverse approaches. He also emphasizes the complexity of decision making in actual clinical situations and the urgent need for more research to help clinicians gain additional insight and understanding regarding their decision making.