Silverstein A M
Johns Hopkins University School of Medicine, Baltimore, MD 21204, USA.
Doc Ophthalmol. 1997;94(1-2):25-37. doi: 10.1007/BF02629679.
Just as different fads that seize the imagination of the general public are often carried to excess, so diagnostic or therapeutic fads may take over in the practice of medicine. Analysis of 33 surveys of the causes of uveitis reported by ophthalmologists over the course of 120 years shows how some diagnoses such as syphilis and tuberculosis fell from favor because tests ruled out these diseases, whereas others such as toxoplasmosis became popular because of the finding of the organism in a few cases by a famous ophthalmic pathologist. Yet others (pars planitis, sarcoidosis) were not even causes of disease, but rather merely descriptive, or the ocular component of a systemic disease whose etiology and pathogenesis remain unknown. We will examine the waxing and waning of these diagnostic categories and the impressive confidence of some clinicians in their own diagnostic acumen as they made diagnoses often unsupported by objective evidence.
正如那些抓住普通大众想象力的不同时尚潮流常常走向极端一样，诊断或治疗时尚潮流也可能在医学实践中占据主导。对眼科医生在120年期间报告的33项葡萄膜炎病因调查进行分析后发现，一些诊断，如梅毒和结核病，由于检测排除了这些疾病而不再受青睐，而其他一些诊断，如弓形虫病，因一位著名眼科病理学家在少数病例中发现了该病原体而变得流行起来。还有一些情况（周边性葡萄膜炎、结节病）甚至并非疾病的病因，而仅仅是描述性的，或者是一种病因和发病机制仍不明的全身性疾病的眼部表现。我们将审视这些诊断类别的兴衰，以及一些临床医生在做出往往缺乏客观证据支持的诊断时，对自身诊断敏锐度所表现出的令人印象深刻的自信。
