Isoda Sho, Shimizu Taro, Hashimoto Tadayuki, Shimada Fumio, Misawa Miwa, Suzuki Tomio
Department of General Medicine, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan.
Psychology Division, Graduate School of Human Science, Ritsumeikan University, Ibaraki, Osaka, Japan.
J Eval Clin Pract. 2025 Sep;31(6):e70267. doi: 10.1111/jep.70267.
Physicians sometimes encounter various types of gut feelings (GFs) during clinical diagnosis. The type of GF addressed in this paper refers to the intuitive sense that the generated hypothesis might be incorrect. An appropriate diagnosis cannot be obtained unless these GFs are articulated and inventive solutions are devised. Thus, the method of articulating GFs is critical.
The current study proposes reflective verbalization (RV) to help healthcare professionals capitalize on their GF. In cognitive psychology, RV is the process of verbalizing one's thoughts and feelings through metacognition, to promote deeper understanding and insight problem-solving. When applied to clinical reasoning, RV can help doctors verbalize their GFs, refining their diagnostic hypotheses.
To address GFs systematically using RV, we introduce the DATES approach, comprising five perspectives: Degree, Abandoned, Time course, Excess, and Shortage. Each perspective prompts physicians to compare their patient's information against typical illness scripts, ensuring no detail is omitted or overlooked.
The tool also aids physicians in considering possible differential diagnoses for one or more of these elements. This guiding tool may aid physicians in overcoming biases, including confirmation and anchoring biases, thus improving diagnostic accuracy. This tool is useful for healthcare professionals who wish to improve their clinical reasoning and decision-making abilities, particularly when they encounter inexplicable contradictions in their diagnostic hypotheses.
医生在临床诊断过程中有时会遇到各种类型的直觉感受（GFs）。本文所讨论的GF类型是指那种认为所产生的假设可能不正确的直觉。除非这些直觉感受能够被清晰表达并想出创造性的解决方案，否则无法获得恰当的诊断。因此，清晰表达直觉感受的方法至关重要。
本研究提出反思性言语表达（RV），以帮助医疗保健专业人员利用他们的直觉感受。在认知心理学中，RV是通过元认知将个人的想法和感受用言语表达出来的过程，以促进对问题解决的更深入理解和洞察。当应用于临床推理时，RV可以帮助医生用言语表达他们的直觉感受，完善他们的诊断假设。
为了使用RV系统地处理直觉感受，我们引入了DATES方法，它包含五个视角：程度、放弃、时间进程、过度和不足。每个视角促使医生将患者的信息与典型的疾病脚本进行比较，确保没有细节被遗漏或忽视。
该工具还帮助医生考虑这些因素中一个或多个因素的可能鉴别诊断。这个指导工具可能有助于医生克服偏见，包括确认性偏见和锚定偏见，从而提高诊断准确性。这个工具对于希望提高临床推理和决策能力的医疗保健专业人员很有用，特别是当他们在诊断假设中遇到无法解释的矛盾时。
