Undergraduate Medical School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
Diagnosis (Berl). 2023 Jul 4;10(3):235-241. doi: 10.1515/dx-2022-0100. eCollection 2023 Aug 1.
Context specificity refers to the vexing phenomenon whereby a physician can see two patients with the same presenting complaint, identical history and physical examination findings, but due to specific situational (contextual) factors arrives at two different diagnostic labels. Context specificity remains incompletely understood and undoubtedly leads to unwanted variance in diagnostic outcomes. Previous empirical work has demonstrated that a variety of contextual factors impacts clinical reasoning. These findings, however, have largely focused on the individual clinician; here we broaden this work to reframe context specificity in relation to clinical reasoning by an internal medicine rounding team through the lens of Distributed Cognition (DCog). In this model, we see how meaning is distributed amongst the different members of a rounding team in a dynamic fashion that evolves over time. We describe four different ways in which context specificity plays out differently in team-based clinical care than for a single clinician. While we use examples from internal medicine, we believe that the concepts we present apply equally to other specialties and fields in health care.
语境特异性是指一种令人困扰的现象，即医生可以看到两个具有相同主诉、相同病史和体检结果的患者，但由于特定的情境（语境）因素，却得出了两个不同的诊断标签。语境特异性仍然未被完全理解，无疑会导致诊断结果出现不必要的差异。先前的实证研究表明，各种情境因素会影响临床推理。然而，这些发现主要集中在个体医生身上；在这里，我们通过分布式认知（DCog）的视角，将这项工作扩展到内科查房团队的临床推理中，重新定义语境特异性。在这个模型中，我们可以看到在一个动态的过程中，意义是如何在查房团队的不同成员之间分配的，并且这种分配会随着时间的推移而演变。我们描述了在以团队为基础的医疗护理中，语境特异性与单个医生的情况相比，表现出的四种不同方式。虽然我们使用了内科的例子，但我们相信，我们提出的概念同样适用于医疗保健的其他专业和领域。
