Evidence base of clinical diagnosis: Clinical problem solving and diagnostic decision making: selective review of the cognitive literature

摘要: This is the fourth in a series of five articles This article reviews our current understanding cognitive processes involved diagnostic reasoning clinical medicine. It describes and analyses psychological employed identifying solving problems errors pitfalls light two particularly influential approaches: problem solving1, 2, 3 decision making.4, 5, 6, 7, 8 Problem research was initially aimed at describing by expert physicians, to improve instruction medical students house officers. Psychological has been influenced from start statistical models under uncertainty, concentrated on departures these standards. #### Summary points Problem making are paradigms for reasoning, each with its own assumptions methods The choice strategy depends perceived difficulty case knowledge content as well strategy Final conclusions should depend both prior belief strength evidence Conclusions reached Bayes's theorem intuition may conflict Because limitations, systematic biases result employing simpler rather than more complex strategies Evidence based medicine applies theory diagnosis ### Diagnosis selecting hypothesis The earliest formulation viewed process testing hypotheses. Solutions difficult were found generating limited number hypotheses early using them guide subsequent collection data.1 Each hypothesis can be used predict what additional findings ought present if it true, guided search findings. Experienced physicians form their plan rapidly, …