Schattner Ami
Department of Medicine, Kaplan Medical Centre, Rehovot, Hebrew University Hadassah Medical School, Jerusalem, Israel.
Med J Aust. 2006 Sep 4;185(5):273-5. doi: 10.5694/j.1326-5377.2006.tb00750.x.
Despite astounding advances in scientific knowledge and technological capabilities, modern medicine is not free of significant problems. A persistent high rate of diagnostic errors, the prevalence of medical (iatrogenic) harm and the growing demand for complementary and alternative medicine indicate an urgent need for improvement. An important step is a return to three quintessential clinical paradigms that have become neglected with the advent of high-technology medicine: the need to emphasise prevention and early, presymptomatic diagnosis; the crucial role in decision making of skillful history taking and examination, backed by evidence; and enhanced attention to patient autonomy and emotional factors. Possible reasons for the current neglect of these Altneuparadigms ("old-new" paradigms) are considered, and techniques for restoring their primacy in medicine are discussed.
尽管科学知识和技术能力取得了惊人的进步，但现代医学并非没有重大问题。持续的高诊断错误率、医源性伤害的普遍存在以及对补充和替代医学的需求不断增加，表明迫切需要改进。重要的一步是回归到随着高科技医学的出现而被忽视的三个典型临床范式：强调预防和早期症状前诊断的必要性；以证据为后盾的熟练病史采集和检查在决策中的关键作用；以及加强对患者自主性和情感因素的关注。文中考虑了当前忽视这些旧新范式的可能原因，并讨论了恢复它们在医学中首要地位的技术。
