Croskerry Pat
Department of Emergency Medicine, Dalhousie University, NS, Canada.
Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:27-35. doi: 10.1007/s10459-009-9182-2. Epub 2009 Aug 11.
Both systemic and individual factors contribute to missed or delayed diagnoses. Among the multiple factors that impact clinical performance of the individual, the caliber of cognition is perhaps the most relevant and deserves our attention and understanding. In the last few decades, cognitive psychologists have gained substantial insights into the processes that underlie cognition, and a new, universal model of reasoning and decision making has emerged, Dual Process Theory. The theory has immediate application to medical decision making and provides an overall schema for understanding the variety of theoretical approaches that have been taken in the past. The model has important practical applications for decision making across the multiple domains of healthcare, and may be used as a template for teaching decision theory, as well as a platform for future research. Importantly, specific operating characteristics of the model explain how diagnostic failure occurs.
系统性因素和个体因素都会导致漏诊或诊断延迟。在影响个体临床行为的诸多因素中，认知能力或许最为关键，值得我们关注和理解。在过去几十年里，认知心理学家对认知背后的过程有了深入了解，一种全新的、通用的推理与决策模型——双加工理论应运而生。该理论可直接应用于医学决策，并为理解过去采用的各种理论方法提供了一个总体框架。该模型在医疗保健的多个领域的决策中具有重要的实际应用价值，可作为决策理论教学的模板，也可作为未来研究的平台。重要的是，该模型的特定运行特征解释了诊断失误是如何发生的。
