Campbell Graeme, Watters David A K
Department of Surgery, Bendigo Health, Bendigo, Victoria, Australia.
ANZ J Surg. 2013 Jun;83(6):429-33. doi: 10.1111/ans.12193. Epub 2013 May 8.
Good decision making is essential in surgery. In an emergency, the time for decision making is often short, and the information available is incomplete. The way experienced surgeons make decisions is often not well understood, and therefore is difficult to teach to trainees.
This paper examines how decisions are made, based on recent literature and the experience of the authors and their colleagues.
An accurate assessment precedes decision making, and is directed towards the patient, the personnel and environment. Studies of other high-stakes professions have highlighted the existence of two distinct mental processing symptoms. One is fast and frugal, relying on pattern recognition or following a rule or protocol. This is often performed at a subconscious level. The other is a conscious, reasoned, analytical process. This requires adequate, available mental capacity. In reality, expert and experienced decision makers can adopt either or both approaches, and match their approach to the situation. Decisions made need to be constantly reviewed, particularly where there is mismatch between what was anticipated and what is encountered.
An algorithm of decision making in emergency surgery has been developed that is based on assessment, the decision required and the outcome of the decision. The decision must also consider the urgency of the situation and the likely outcome if the plan made fails.
良好的决策在外科手术中至关重要。在紧急情况下，决策时间往往很短，且可用信息不完整。经验丰富的外科医生的决策方式常常未得到充分理解，因此难以传授给实习生。
本文基于近期文献以及作者及其同事的经验，探讨决策是如何做出的。
准确的评估先于决策，且针对患者、人员和环境。对其他高风险职业的研究突出了两种不同的心理加工模式的存在。一种快速且简便，依赖模式识别或遵循规则或方案。这通常在潜意识层面进行。另一种是有意识的、理性的、分析性的过程。这需要足够的可用心理能力。实际上，专家和经验丰富的决策者可以采用其中一种或两种方法，并根据情况匹配他们的方法。做出的决策需要不断审查，特别是在预期与实际遇到的情况不匹配时。
已开发出一种基于评估、所需决策和决策结果的急诊手术决策算法。决策还必须考虑情况的紧迫性以及如果所制定的计划失败可能产生的结果。
