Djulbegovic B, Hozo I, Abdomerovic I, Hozo S
University of Louisville, Department of Medicine, James Graham Brown Cancer Center, KY 40292, USA.
Med Hypotheses. 1995 Nov;45(5):503-9. doi: 10.1016/0306-9877(95)90231-7.
Current clinical practice is based upon 'out stubborn quest for diagnostic certainty' which in turn is considered as one of the major reasons for ever-increasing health costs. We linked a treatment-threshold concept with classic information theory to show that measurable clinical variables, such as benefit and risk of available treatments, can be used to calculate the acceptable levels of diagnostic uncertainties associated with a particular clinical situation. Our analysis shows that practising physicians should aim for diagnostic certainty only when the benefit of treatment is equal to its associated risk. In all other cases, decisions about treatment do not have to rely on maximum diagnostic certainty. Determination of acceptable levels of diagnostic uncertainty according to the concepts outlined here should lead to improvement of clinical practice and decrease healthcare costs.
当前的临床实践基于“对诊断确定性的顽固追求”，而这反过来又被视为医疗成本不断攀升的主要原因之一。我们将治疗阈值概念与经典信息理论相结合，以表明可测量的临床变量，如现有治疗的益处和风险，可用于计算与特定临床情况相关的可接受诊断不确定性水平。我们的分析表明，执业医师只有在治疗益处等于其相关风险时才应追求诊断确定性。在所有其他情况下，治疗决策不必依赖于最大诊断确定性。根据此处概述的概念确定可接受的诊断不确定性水平应能改善临床实践并降低医疗成本。
