Kuhn Gloria J
Department of Emergency Medicine, Wayne State University, Detroit, MI 48201, USA.
Acad Emerg Med. 2002 Jul;9(7):740-50. doi: 10.1111/j.1553-2712.2002.tb02155.x.
One of the most complex and challenging tasks facing physicians is the need to make a diagnosis. Recent research has focused attention on medical errors alleged to have resulted in increased patient morbidity and mortality. A number of authorities have suggested methods to track and prevent errors. Most have dealt with systems' changes and fail-safe methods to prevent medication errors and commission of errors during treatment. Few have addressed methods to find and prevent diagnostic errors. Unless diagnostic error is either avoided or corrected early, fail-safe methods to prevent medication and treatment errors will ultimately fail to improve patient outcome. American medical literature, particularly postmortem studies, have documented diagnostic error since at least 1912. European literature shows the problem is worldwide. The limits of human memory and errors in both observation and processing of information during problem solving contribute to the commission of errors. The purpose of this article is to examine the thinking patterns and cognitive errors that can result in diagnostic error, and suggest instructional strategies that can be used to alert residents and attending physicians to these potential problems so they can be avoided.
医生面临的最复杂且最具挑战性的任务之一就是做出诊断。近期研究已将注意力集中在据称导致患者发病率和死亡率上升的医疗差错上。一些权威人士提出了追踪和预防差错的方法。大多数方法都涉及系统变革和故障安全方法，以防止用药差错以及治疗过程中的差错。很少有方法涉及查找和预防诊断差错。除非尽早避免或纠正诊断差错，否则防止用药和治疗差错的故障安全方法最终将无法改善患者的治疗结果。至少自1912年以来，美国医学文献，尤其是尸检研究，已记录了诊断差错。欧洲文献表明这个问题在全球都存在。人类记忆的局限性以及在解决问题过程中观察和处理信息时出现的差错都会导致差错的发生。本文的目的是研究可能导致诊断差错的思维模式和认知差错，并提出可用于提醒住院医师和主治医生注意这些潜在问题以便避免这些问题的教学策略。
