Bushyhead J B, Christensen-Szalanski J J
Med Decis Making. 1981;1(2):115-23. doi: 10.1177/0272989X8100100203.
This paper discusses the effect of feedback from an imperfect diagnostic test-ordering decision upon clinicians' ability to evaluate their management strategies. It presents data from a medical outpatient clinic that show that physicians rely on chest radiographs to diagnose pneumonia but fail to request them for all patients with pneumonia. The data show that physicians preferentially use clinical attributes associated with pneumonia as perceived from the feedback of this imperfect chest radiograph-ordering decision (p less than 0.001) even though the attributes do not predict pneumonia as accurately as clinical attributes associated with all pneumonia cases (p less than 0.001). It is concluded that incomplete feedback based on an imperfect chest radiograph-ordering decision may perpetuate inefficient chest radiograph ordering patterns.
本文讨论了不完美的诊断检查开单决策所产生的反馈对临床医生评估其管理策略能力的影响。文中展示了一家门诊的数据，数据表明医生依赖胸部X光片来诊断肺炎，但并未对所有肺炎患者都进行该项检查。数据显示，尽管这些特征对肺炎的预测不如所有肺炎病例的临床特征准确（p<0.001），但医生仍优先使用从不完美的胸部X光片开单决策反馈中感知到的与肺炎相关的临床特征（p<0.001）。研究得出结论，基于不完美的胸部X光片开单决策的不完整反馈可能会使低效的胸部X光片开单模式长期存在。
