Elstein Arthur S
Department of Medical Education, University of Illinois at Chicago, Chicago, IL, USA.
Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:7-18. doi: 10.1007/s10459-009-9184-0. Epub 2009 Aug 11.
This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to show how these led to greater emphasis on the role of clinical experience and prior knowledge in diagnostic reasoning; (d) to review some common errors in diagnostic reasoning; (e) to examine strategies to reduce the rate of diagnostic errors, including evidence-based medicine and systematic reviews to augment personal knowledge, guidelines and clinical algorithms, computer-based diagnostic decision support systems and second opinions to facilitate deliberation, and better feedback.
（a）回顾《医学问题解决》的科学背景及其中报告的主要研究结果，该书现已被广泛视为该领域的经典之作；（b）将这些结果与近期一本畅销案例研究集中的一些发现进行比较；（c）总结对假设检验模型的批评，并说明这些批评如何导致对临床经验和先验知识在诊断推理中作用的更加强调；（d）回顾诊断推理中的一些常见错误；（e）研究降低诊断错误率的策略，包括循证医学和系统评价以扩充个人知识、指南和临床算法、基于计算机的诊断决策支持系统以及便于深思熟虑的二次诊断意见，还有更好的反馈。
