Rutkow I M
Arch Surg. 1982 Mar;117(3):337-40. doi: 10.1001/archsurg.1982.01380270055012.
A considerable portion of negative surgical second opinions may represent nothing more than reasonable interobserver variation (reliability) among clinicians. In a previous study, four fictional cases were developed for each of seven different disease processes. The appropriate case histories were mailed to a random sample of board-certified surgeons. They were asked to render a decision on the need for elective operative intervention. This report presents a two-year follow-up, in which all surgeons who responded to the original questionnaire were asked to reevaluate the same vignettes. By comparing an individual surgeon's set of responses, the presence of intraobserver variation (reproducibility) was noted. The results of this follow-up showed that a surgeon's judgment with regard to the same hypothetical elective clinical situation seems to differ over time. If both the reproducibility and reliability of clinical surgical judgment are as variable as these studies indicate, then the theoretical premise on which second-opinion programs are based would seem to be in need of reexamination.
相当一部分负面的手术二次诊断意见可能仅仅代表了临床医生之间合理的观察者间差异（可靠性）。在之前的一项研究中，针对七种不同疾病过程中的每一种都设计了四个虚构病例。将适当的病例史邮寄给一组随机抽取的经过委员会认证的外科医生。要求他们就是否需要进行择期手术干预做出决定。本报告呈现了为期两年的随访情况，在此期间，所有回复原始问卷的外科医生都被要求重新评估相同的病例描述。通过比较个体外科医生的一系列回答，观察到了观察者内差异（可重复性）的存在。这次随访的结果表明，外科医生对于相同假设性择期临床情况的判断似乎会随时间而有所不同。如果临床手术判断的可重复性和可靠性都如这些研究所表明的那样具有多变性，那么二次诊断项目所基于的理论前提似乎就需要重新审视了。
