Hu W, Kerridge I, Kemp A
Department of Allergy, Immunology, and Infectious Diseases, The Children's Hospital at Westmead, Locked Bag 4001, Westmead NSW 2145, Australia.
Med Humanit. 2005 Jun;31(1):12-6. doi: 10.1136/jmh.2004.000179.
Risk and uncertainty are unavoidable in clinical medicine. In the case of childhood food allergy, the dysphoric experience of uncertainty is heightened by the perception of unpredictable danger to young children. Medicine has tended to respond to uncertainty with forms of rational decision making. Rationality cannot, however, resolve uncertainty and provides an insufficient account of risk. This paper compares the medical and parental accounts of two peanut allergic toddlers to highlight the value of emotions in decision making. One emotion in particular, regret, assists in explaining the actions taken to prevent allergic reactions, given the diffuse nature of responsibility for children. In this light, the assumption that doctors make rational judgments while patients have emotion led preferences is a false dichotomy. Reconciling medical and lay accounts requires acknowledgement of the interrelationship between the rational and the emotional, and may lead to more appropriate clinical decision making under conditions of uncertainty.
风险和不确定性在临床医学中是不可避免的。就儿童食物过敏而言，不确定性带来的烦躁体验因人们认为幼儿面临不可预测的危险而加剧。医学往往通过理性决策的方式来应对不确定性。然而，理性并不能解决不确定性问题，且对风险的解释也不充分。本文比较了两名花生过敏幼儿的医学描述和家长描述，以突出情感在决策中的价值。尤其是后悔这种情绪，鉴于对儿童的责任具有分散性，它有助于解释为预防过敏反应而采取的行动。据此，认为医生进行理性判断而患者有情绪化偏好的假设是一种错误的二分法。协调医学描述和外行描述需要承认理性与情感之间的相互关系，并可能在不确定性条件下带来更恰当的临床决策。
