Siegel J D, Parrino T A
Evans Memorial Department of Clinical Research, Boston, Massachusetts.
Med Educ. 1988 Jan;22(1):47-54. doi: 10.1111/j.1365-2923.1988.tb00408.x.
The advent of the small computer as a basic clinical tool will have a significant impact on clinical practice and medical training. The application of probability theory to clinical diagnosis has led to the development of several practical diagnostic programs which run on small computers. Expert systems--interactive programs which function as 'electronic consultants'--have now been successfully developed for a number of clinical situations. Experience with two of these, INTERNIST/CADUCEUS and MYCIN, has provided insight into problems and prospects for expert systems in medicine. Less complex programs, particularly those employing clinical prediction rules, and expert system shells, seem well suited for clinical environments. Although computerized medical diagnosis holds great promise as an aid to clinicians, its success will largely be determined by the quality of the information that clinicians provide for analysis. A brief review of the status of bedside diagnosis reveals that data-gathering strategies and techniques must be better understood. In order to take full advantage of computer programs for diagnosis, basic diagnostic skills must be more heavily emphasized in clinical training.
小型计算机作为一种基本临床工具的出现，将对临床实践和医学培训产生重大影响。概率论在临床诊断中的应用促使了一些在小型计算机上运行的实用诊断程序的开发。专家系统——作为“电子顾问”发挥作用的交互式程序——现已成功开发用于多种临床情况。对其中两个系统INTERNIST/CADUCEUS和MYCIN的经验，为医学专家系统的问题和前景提供了见解。不太复杂的程序，特别是那些采用临床预测规则的程序和专家系统外壳，似乎很适合临床环境。尽管计算机化医学诊断作为临床医生的辅助手段前景广阔，但其成功很大程度上将取决于临床医生提供用于分析的信息质量。对床边诊断现状的简要回顾表明，必须更好地理解数据收集策略和技术。为了充分利用计算机诊断程序，临床培训必须更加强调基本诊断技能。
