Peterson M C, Holbrook J H, Von Hales D, Smith N L, Staker L V
Department of Medicine, West Virginia University, Morgantown.
West J Med. 1992 Feb;156(2):163-5.
We report an attempt to quantitate the relative contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. In this prospective study of 80 medical outpatients with new or previously undiagnosed conditions, internists were asked to list their differential diagnoses and to estimate their confidence in each diagnostic possibility after the history, after the physical examination, and after the laboratory investigation. In 61 patients (76%), the history led to the final diagnosis. The physical examination led to the diagnosis in 10 patients (12%), and the laboratory investigation led to the diagnosis in 9 patients (11%). The internists' confidence in the correct diagnosis increased from 7.1 on a scale of 1 to 10 after the history to 8.2 after the physical examination and 9.3 after the laboratory investigation. These data support the concept that most diagnoses are made from the medical history. The results of physical examination and the laboratory investigation led to fewer diagnoses, but they were instrumental in excluding certain diagnostic possibilities and in increasing the physicians' confidence in their diagnoses.
我们报告了一项旨在量化病史、体格检查及实验室检查在做出医学诊断时相对贡献的尝试。在这项针对80名患有新的或既往未确诊疾病的内科门诊患者的前瞻性研究中，要求内科医生列出他们的鉴别诊断，并在病史采集后、体格检查后及实验室检查后评估他们对每种诊断可能性的信心。在61名患者（76%）中，病史导向了最终诊断。体格检查导向诊断的有10名患者（12%），实验室检查导向诊断的有9名患者（11%）。内科医生对正确诊断的信心从病史采集后的1至10分制中的7.1分，升至体格检查后的8.2分及实验室检查后的9.3分。这些数据支持了多数诊断源自病史这一概念。体格检查及实验室检查结果导向的诊断较少，但它们有助于排除某些诊断可能性，并增强医生对其诊断的信心。
