van Ginneken A M, van der Lei J
Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands.
Proc Annu Symp Comput Appl Med Care. 1991:99-103.
The Diagnostic Encyclopedia Workstation (DEW) was developed to support pathologists in diagnosing ovarian tumors. In this evaluation study, we had pathologists at several levels of experience diagnose a number of cases using either books or the DEW. In the context of this study, we needed a standard by which to measure performance of these pathologists. We, therefore, had experts enumerate for each test case the diagnoses they considered morphologically similar. To our surprise, the resulting lists of the experts varied considerably. The differential diagnosis of a disease based on its morphological characteristics, however, constitutes important reference knowledge in solving diagnostic problems. The question rose why the experts differed so much in their differential diagnostic knowledge. The ontogeny of a pathologist's personal knowledge is discussed and used to derive a model that can explain the limited consensus in differential diagnosis. The model helps to identify factors that may cause pathologists to diverge and others that may cause them to converge with respect to their knowledge. Strategies are proposed that are useful in achieving a better (differential) diagnostic consensus.
诊断百科工作站（DEW）的开发旨在辅助病理学家诊断卵巢肿瘤。在这项评估研究中，我们让不同经验水平的病理学家使用书籍或DEW诊断一些病例。在本研究的背景下，我们需要一个衡量这些病理学家表现的标准。因此，我们让专家为每个测试病例列举出他们认为在形态学上相似的诊断。令我们惊讶的是，专家们得出的清单差异很大。然而，基于疾病形态特征的鉴别诊断是解决诊断问题的重要参考知识。问题出现了，为什么专家们在鉴别诊断知识上差异如此之大。本文讨论了病理学家个人知识的形成过程，并据此推导出一个模型，该模型可以解释鉴别诊断中有限的共识。该模型有助于识别可能导致病理学家知识出现分歧或趋同的因素。本文还提出了有助于达成更好的（鉴别）诊断共识的策略。
