Simpson D E, Rich E C, Dalgaard K A, Gjerdingen D, Crowson T W, O'Brien D K, Johnson P E
Medical College of Wisconsin, Milwaukee 53226.
Soc Sci Med. 1987;25(7):861-6. doi: 10.1016/0277-9536(87)90044-x.
This investigation examined the formulation of diagnostic hypotheses by general internists and family physicians in response to three patient cases (dyspnea, abdominal pain and syncope). The investigation was conducted in the United States. Physician responses to sequentially presented written clinical information were audiotaped. Each transcribed protocol was scored to enumerate and characterize the hypotheses considered by physicians in each specialty. Results of the analyses of variance of hypothesis measures revealed that internists generated more hypotheses than family physicians and that the internist's hypotheses were more specific and were less likely to be generated by other physicians. In addition, internists tended to consider hypotheses more closely related to the final diagnosis sooner in the case presentation than did family physicians. The findings of increased number, specificity, and uniqueness of hypothesis considered by internists are consistent with previously demonstrated differences in the amount and nature of diagnostic information collected by family physicians and internists.
本研究调查了普通内科医生和家庭医生针对三个患者病例（呼吸困难、腹痛和晕厥）形成诊断假设的情况。该研究在美国进行。医生对依次呈现的书面临床信息的反应被录音。对每份转录的记录进行评分，以列举和描述每个专业的医生所考虑的假设。假设测量的方差分析结果显示，内科医生比家庭医生产生的假设更多，并且内科医生的假设更具体，其他医生产生这些假设的可能性较小。此外，与家庭医生相比，内科医生在病例呈现过程中更早倾向于考虑与最终诊断更密切相关的假设。内科医生考虑的假设在数量、特异性和独特性方面增加的结果，与之前证明的家庭医生和内科医生收集的诊断信息的数量和性质差异一致。
