Moskowitz A J, Kuipers B J, Kassirer J P
Department of Medicine, Tufts University School of Medicine, New England Medical Center, Boston Massachusetts.
Ann Intern Med. 1988 Mar;108(3):435-49. doi: 10.7326/0003-4819-108-3-435.
To generate hypotheses about how physicians make difficult clinical decisions, we analyzed transcripts of the "thinking aloud" behavior of expert clinicians making a testing or treatment decision with an uncertain diagnosis. We compared the clinicians' reasoning with a decision analysis of the same problem. The experts did not formulate a global outline of their decision, but chained together a sequence of decisions based on available and incomplete information. Despite effective and efficient problem solving, the clinicians used numeric terms only as symbolic representations of likelihood, used limited information in choosing among alternatives, and dismissed the possibility that a less conventional strategy, empiric therapy, might yield equivalent outcome. We describe cognitive problem-solving strategies and knowledge representations that permit persons to make successful decisions despite limited processing resources. The same cognitive procedures probably contribute to observed errors in decision-making under uncertainty.
为了生成关于医生如何做出艰难临床决策的假设，我们分析了专家临床医生在面对不确定诊断进行检测或治疗决策时 “边想边说” 行为的文字记录。我们将临床医生的推理与对同一问题的决策分析进行了比较。专家们没有制定决策的整体大纲，而是基于可用的不完整信息，将一系列决策链接在一起。尽管临床医生有效地解决了问题，但他们仅将数字术语用作可能性的符号表示，在选择替代方案时使用的信息有限，并且忽略了一种不太传统的策略（经验性治疗）可能产生同等结果的可能性。我们描述了认知问题解决策略和知识表示，这些策略和表示使人们能够在处理资源有限的情况下做出成功的决策。相同的认知过程可能导致在不确定性下决策时出现观察到的错误。
