Department of Neurology, University of California, Los Angeles, CA 90095-1769, USA.
Ann Neurol. 2010 Apr;67(4):425-33. doi: 10.1002/ana.21907.
Physicians use heuristics or shortcuts in their decision making to help them sort through complex clinical information and formulate diagnoses efficiently. Practice would come to a halt without them. However, there are pitfalls to the use of certain heuristics, the same ones to which humans are prone in everyday life. It may be possible to improve clinical decision making through techniques that minimize biases inherent in heuristics. Five common clinical heuristics or other sources of cognitive error are illustrated through neurological cases with missed diagnoses, and literature from cognitive psychology and medicine are presented to support the occurrence of these errors in diagnostic reasoning as general phenomena. Articulation of the errors inherent in certain common heuristics alerts clinicians to their weaknesses as diagnosticians and should be beneficial to practice. Analysis of cases with missed diagnoses in teaching conferences might proceed along formal lines that identify the type of heuristic used and of inherent potential cognitive errors. Addressing these cognitive errors by becoming conscious of them is a useful tool in neurologic education and should facilitate a career-long process of continuous self-improvement.
医生在决策中使用启发式或快捷方式来帮助他们梳理复杂的临床信息并有效地制定诊断。如果没有这些方法，实践将会停滞不前。然而，某些启发式方法的使用存在陷阱，这些陷阱也是人类在日常生活中容易犯的错误。通过最小化启发式方法中固有的偏见的技术，可能可以改善临床决策。通过神经病例和认知心理学和医学文献来说明五种常见的临床启发式方法或其他认知错误来源，以支持这些错误在诊断推理中作为普遍现象的发生。某些常见启发式方法中固有的错误的阐明提醒临床医生作为诊断者的弱点，这对实践应该是有益的。在教学会议中分析漏诊病例可以按照确定使用的启发式方法和固有的潜在认知错误的类型的正式方式进行。通过意识到这些认知错误来解决它们是神经教育中的一个有用工具，应该有助于终身不断自我完善的过程。
