Clark Bennett W, Derakhshan Arsalan, Desai Sanjay V
Department of Internal Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Department of Internal Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
Med Clin North Am. 2018 May;102(3):453-464. doi: 10.1016/j.mcna.2017.12.007.
Diagnostic errors are common in clinical practice and lead to adverse patient outcomes. Systematic reviews have shown that inadequate history taking and physical examination lead to a plurality, if not a majority, of diagnostic errors. Recent advances in cognitive science have also shown that unconscious biases likely contribute to many diagnostic errors. Research into diagnostic error has been hampered by methodologic inconsistency and a paucity of studies in real-world clinical settings. The best evidence indicates that educational interventions to reduce diagnostic error should give physicians feedback about clinical outcomes and enhance their ability to recognize signs and symptoms of specific diseases at the bedside.
诊断错误在临床实践中很常见，并会导致不良的患者预后。系统评价表明，病史采集和体格检查不充分即便不是导致大多数诊断错误，也会导致大量诊断错误。认知科学的最新进展还表明，无意识偏见可能导致许多诊断错误。对诊断错误的研究受到方法不一致以及真实临床环境中研究匮乏的阻碍。最佳证据表明，减少诊断错误的教育干预措施应向医生提供有关临床结果的反馈，并提高他们在床边识别特定疾病体征和症状的能力。
