Department of General Practice, University of Marburg, Marburg, Germany
Ann Fam Med. 2018 Jul;16(4):353-358. doi: 10.1370/afm.2264.
Arriving at an agreed-on and valid explanation for a clinical problem is important to patients as well as to clinicians. Current theories of how clinicians arrive at diagnoses, such as the threshold approach and the hypothetico-deductive model, do not accurately describe the diagnostic process in general practice. The problem space in general practice is so large and the prior probability of each disease being present is so small that it is not realistic to limit the diagnostic process to testing specific diagnoses on the clinician's list of possibilities. Here, new evidence is discussed about how patients and clinicians collaborate in specific ways, in particular, via a process that can be termed inductive foraging, which may lead to information that triggers a diagnostic routine. Navigating the diagnostic challenge and using patient-centered consulting are not separate tasks but rather synergistic.
对于患者和临床医生来说，对临床问题达成一致且有效的解释非常重要。目前关于临床医生如何做出诊断的理论，如阈值方法和假设演绎模型，并不能准确描述一般实践中的诊断过程。一般实践中的问题空间如此之大，每种疾病的先验概率如此之小，以至于将诊断过程限制为在临床医生的可能性列表上测试特定诊断是不现实的。在这里，我们将讨论有关患者和临床医生如何以特定方式合作的新证据，特别是通过可以称为归纳式搜索的过程，这可能会导致触发诊断程序的信息。驾驭诊断挑战和使用以患者为中心的咨询不是单独的任务，而是相辅相成的。
