Rausch F
J R Coll Physicians Lond. 1978 Apr;12(3):272-85.
The first principle in diagnosis, as in treatment, is: nil nocere. Modern methods of diagnosis are becoming more and more technical. They often create physical and mental stress to the patient, and have undesirable side-effects of varying kinds and degrees. To be aware of contra-indications is important not only for the doctor but also for the patient, who must be informed of the risk of a diagnostic procedure. The data presented gives statistical information from which the doctor can see the number likely to be at risk from his diagnostic methods. The most common methods and their adverse effects are mentioned: intravenous use of X-ray contrast media, invasive tests (peripheral, cerebral, coronary, renal angiographs), laparoscopies with and without liver biopsies, kidney biopsies, endoscopies (oesophago-gastro-duodenoscopy, colonoscopy, retrograde cholangio-pancreatography), percutaneous lung biopsy and mammography. Although the mortality rates of all methods of diagnosis, even the most hazardous ones, are relatively low, all techniques create a stress to which not every patient is accustomed; they all demand considerable co-operation for which not every patient is prepared. There is now a trend towards non-invasive diagnostic techniques, creating little or no stress, but which nevertheless give at least a comparable level of diagnostic efficiency (e.g. ultrasonics, isotopes and computer tomography).
诊断的首要原则，如同治疗一样，是：切勿伤害。现代诊断方法正变得越来越技术化。它们常常给患者造成身心压力，并且有各种不同类型和程度的不良副作用。了解禁忌证不仅对医生很重要，对患者也很重要，患者必须被告知诊断程序的风险。所呈现的数据提供了统计信息，医生可以从中看出可能因他的诊断方法而面临风险的人数。文中提到了最常见的方法及其不良反应：静脉使用X射线造影剂、侵入性检查（外周、脑血管、冠状动脉、肾血管造影）、有无肝活检的腹腔镜检查、肾活检、内镜检查（食管-胃-十二指肠镜检查、结肠镜检查、逆行胰胆管造影）、经皮肺活检和乳房X线摄影。尽管所有诊断方法，即使是最危险的方法，死亡率都相对较低，但所有技术都会造成一种并非每个患者都习惯承受的压力；它们都需要患者有相当程度的配合，而并非每个患者都做好了准备。现在有一种趋势是采用无创诊断技术，这种技术几乎不会或根本不会造成压力，但却能提供至少相当的诊断效率水平（例如超声、同位素和计算机断层扫描）。
