Ludden J
Department of Ambulatory Care and Prevention, Harvard Medical School, Cambridge, MA, USA.
Physician Exec. 1999 Jul-Aug;25(4):24-30.
Medical care presents complex problems to physician executives--thoughtful problem definition is a crucial management task. Without understanding the context, cultures, bottom line implications, and personal relevance, problem definition is incomplete and problem resolution may be inadequate or inappropriate. If our choices are complex, some of the difficulty may lie in our understanding of the problem. Until we have properly defined the problem, we can't act to resolve it. We need to step back, reframe the issue, ask if it feels right, and understand the whole story, not just the situation at hand. The tests of an organized story are coherence, direction, meaning, and implication. These should be perceptible both as individual attributes and as a whole. The purpose of such a story is not the resolution of the problem, but a coherent understanding of the direction to be taken. When the diagnostic work-up is complete, the next step can begin.
医疗保健给医师管理人员带来了复杂的问题——深思熟虑地界定问题是一项至关重要的管理任务。如果不了解背景、文化、底线影响以及个人相关性，问题界定就是不完整的，问题解决可能也会不充分或不恰当。如果我们面临的选择很复杂，部分困难可能在于我们对问题的理解。在我们正确界定问题之前，我们无法采取行动来解决它。我们需要退一步，重新构建问题，问问这样是否合理，并了解整个情况，而不仅仅是眼前的状况。一个有条理的情况描述的检验标准是连贯性、方向性、意义和影响。这些既应作为个体属性，也应作为一个整体被感知到。这样一个情况描述的目的不是解决问题，而是对要采取的方向有一个连贯的理解。当诊断检查完成后，下一步就可以开始了。
