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首页> 外文期刊>Clinical Chemistry: Journal of the American Association for Clinical Chemists >Clinical Chemistry’s NIH Book Club Corner, NIH Biomedical Computing Interest Group Book Club Review of How Doctors Think by Jerome Groopman. Jim DeLeo, Alan T. Remaley, G. William Moore, Gerald L. McLaughlin, Ellen J. Bicknell, and Melanie Swan.
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Clinical Chemistry’s NIH Book Club Corner, NIH Biomedical Computing Interest Group Book Club Review of How Doctors Think by Jerome Groopman. Jim DeLeo, Alan T. Remaley, G. William Moore, Gerald L. McLaughlin, Ellen J. Bicknell, and Melanie Swan.

机译：临床化学的NIH图书俱乐部角落，NIH生物医学计算兴趣小组图书俱乐部，作者Jerome Groopman评论医生的想法。 Jim DeLeo，Alan T.Remaley，G.William Moore，Gerald L.McLaughlin，Ellen J.Bicknell和Melanie Swan。

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This book explores how physicians make difficult diagnoses. Cognitive processes, not merely learning correlations between symptoms and diseases, must be an integral part of clinical medicine. We are introduced to a woman with abdominal complaints, undiagnosed for more than 15 years. Finally, a physician carefully listens to her entire story, and makes the correct diagnosis. A patient with sudden shortness of breath is rescued by a visiting cardiologist, who quickly makes the diagnosis using pattern recognition and heuristics.Most medical errors are mistakes in thinking. Patients may be misdiagnosed due to the physician’s positive or negative social stereotypes. Errors may result from availability errors (recent experience) and confirmation bias (disregarding data inconsistent with one’s first guess), according to economics Nobel laureates Tversky and Kahneman. Patients can assume active roles by asking questions and helping to shape physician thinking. The time that medical gatekeepers (general internists, general pediatricians, and family practitioners) spend talking with patients is undervalued. Cognitive bias (matching the patient to a familiar prototype), zebra retreat (avoiding a rare diagnosis), and diagnosis momentum (passing along a first-impression diagnosis to peers) point physicians to a misdiagnosis. Physicians should accept uncertainty as an intrinsic feature of medical practice. The author-as-patient consulted 6 surgeons for a long-standing hand ailment, received 4 different diagnoses, and chose the surgeon with the best cognitive assessment. Current medical knowledge cannot entirely rely on evidence-based medicine and clinical trials for individual diagnoses and treatment. The author discusses errors that radiologists make in their practice, although similar errors are also made in other specialties. One problem may be an increase in the complexity and number of images that are …
机译：本书探讨了医生如何做出困难的诊断。认知过程，不仅是学习症状和疾病之间的相关性，还必须是临床医学不可或缺的一部分。我们被介绍给一名患有腹部不适的妇女，她被诊断超过15年。最后，医生会仔细听她的整个故事，并做出正确的诊断。一位来访的心脏病专家救出了一名突然呼吸急促的患者，他利用模式识别和启发式方法迅速做出诊断。大多数医疗错误都是思维中的错误。由于医生的正面或负面社会刻板印象，可能会误诊患者。诺贝尔经济学奖得主特维尔斯基和卡尼曼说，错误可能是由于可用性错误（最近的经验）和确认偏差（忽略与首次猜测不一致的数据）造成的。通过提问和帮助塑造医生的思维，患者可以扮演积极的角色。医疗看门人（普通内科医生，儿科医生和家庭医生）与患者交谈的时间被低估了。认知偏差（将患者匹配到熟悉的原型），斑马撤退（避免罕见的诊断）和诊断动力（将首次印象诊断传递给同龄人）将医生误诊。医师应将不确定性视为医学实践的固有特征。作者-患者作为一名长期手部疾病咨询了6位外科医生，接受了4种不同的诊断，并选择了认知评估最佳的外科医生。当前的医学知识不能完全依靠基于证据的医学和临床试验来进行个体诊断和治疗。作者讨论了放射科医生在实践中所犯的错误，尽管在其他专业领域也存在类似的错误。一个问题可能是图像的复杂度和数量增加。

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