医患关系暧昧 怎样避免误诊

The VA has funded a randomized trial to test whether an automated surveillance system of triggers can improve timely diagnosis and follow-up for five common cancers.
退伍军人事务部资助了一个随机试验，测试“触发”自动化监测系统是否能改善五种常见癌症的及时诊断和跟进。

'This program is like finding needles in a haystack, and we use information technology to make the haystack smaller and smaller so it's easier to find the needles,' Dr. Singh says.
辛格博士说：“这个项目就像是在干草堆中找针，我们利用信息技术让干草堆变得越来越小，这样就更容易找到针。”

More health-care systems are also turning to electronic decision-support programs that help doctors rank possible diagnoses by likelihood based on symptoms and notes in the medical record. In a study of one such system, called Isabel, researchers led by Dr. Graber found that it provided the correct diagnosis 96% of the time when key clinical features from 50 challenging cases reported in the New England Journal of Medicine were entered into the system. The American Board of Internal Medicine is studying how Isabel could be linked to assessments of physician skill and knowledge.
越来越多的医疗系统也开始采用电子决策支持程序来帮助医生根据症状和病历笔记为诊断结果的可能性进行排序。在一个名为“伊莎贝尔”(Isabel)的程序的研究中，由格雷伯博士带领的研究小组发现，刊登在《新英格兰医学杂志》(New England Journal of Medicine)上的50个疑难案例中的关键临床特征输入系统时，系统96%的情况下都给出了正确的诊断。美国内科学委员会(The American Board of Internal Medicine)正在研究如何将“伊莎贝尔”与医师技能和知识的评估联系起来。

Another system, DXplain, developed at Massachusetts General Hospital in Boston, was shown in a study last year to significantly improve diagnostic accuracy among first-year medical residents.
另外一个名叫DXplain的系统是由波士顿麻省总医院(Massachusetts General Hospital)开发的。去年的一项研究显示，该系统能显著增强第一年住院医师诊断的准确性。

Edward Hoffer, associate clinical professor at Harvard and senior computer scientist at Mass General who leads the DXplain program, says the aim now is to have DXplain 'push' diagnostic suggestions to physicians through an electronic-medical-records system rather than requiring doctors to initiate a query, which some are still reluctant to do. 'We have to focus our attention on dealing with situations where doctors think they know what the diagnosis is, but they don't,' Dr. Hoffer says.
负责DXplain项目的是哈佛大学(Harvard)临床副教授、麻省总医院高级计算机科学家爱德华・霍弗(Edward Hoffer)，他说，当前的目标是让DXplain通过电子病例记录系统向医生“推送”诊断建议，而不是要求医生发起查询，有些医生仍然不愿意主动查询。霍弗博士说：“我们要把重点放在处理医生自以为知道诊断结果、但事实上不知道的情况。”

New devices also hold promise for confirming a diagnosis and avoiding unnecessary tests. A number of companies are rushing to provide aids such as portable diagnostic equipment and lab tests that can analyze tiny samples of blood and other bodily fluids quickly to detect disease.
新设备也有望对确认诊断和避免不必要的检查提供帮助。多家公司正加速提供便携式诊断设备和实验室结果等援助，可以帮助分析微小的血样及其他体液，从而迅速发现疾病。

Consider MelaFind, which came to market in the U.S. in 2011. The device allows dermatologists to noninvasively examine moles as deep as 2.5 millimeters beneath the surface to gauge the level of 'disorganization,' an indicator of irregular growth patterns that are a sign of melanoma, among the deadliest cancers.
以2011年进入美国市场的MelaFind为例。皮肤科医生可使用该设备无创检查在皮下深达2.5毫米处的痣，从而检测“组织破坏”的水平。“组织破坏”的水平可反应不规则生长模式，不规则生长模式是黑色素瘤等最致命癌症的迹象。

New York dermatologist Macrene Alexiades-Armenakas says she uses MelaFind to confirm that a mole is to be removed and prioritize the level of disorganization in multiple abnormal moles. In some cases, when another doctor or the patient has been concerned about a mole, MelaFind supported 'clinical diagnosis of a benign mole, thereby sparing them a biopsy,' she says.
纽约皮肤专家麦克兰纳・亚历克西亚德斯-阿门内卡斯(Macrene Alexiades-Armenakas)说，她用MelaFind证实某颗痣是否需要去除，以及对多颗异常痣的“组织破坏”水平进行排序。她说，有时候，当其他医生或病人对某颗痣表示担心时，MelaFind会支持“良性痣的临床诊断，从而让他们省去了活体组织检验的程序”。

But such devices will never replace a thorough physical exam with a trained eye and careful follow-up, says Dr. Alexiades-Armenakas: 'These diagnostic tools are aids to increase our accuracy and adjuncts to good physical diagnosis, not a substitute.'
亚历克西亚德斯-阿门内卡斯博士说，不过这样的设备永远替代不了全面的体检以及训练有素的眼睛和仔细的后续跟进。她说：“这些诊断工具是提高准确性和好的检体诊断的辅助手段，而不是替代手段。”

Some efforts to cut down on errors take a different route altogether -- and try to improve diagnoses by improving communication.
有些尝试减少失误的措施则走的是完全不同的路线──尝试通过改善沟通来改善诊断质量。

For instance, there's a push to get patients more engaged in the diagnostic process, by encouraging them to speak up about their symptoms and ask the doctor, 'What else could this be?' At Kaiser Permanente, a pilot program provides patients with a pamphlet that encourages them to think about and write down their symptoms and what concerns or fears they have, encouraging them to ask specific questions to be sure they understand their diagnosis and the next steps they must take.
例如，有的机构在促使病人在诊断过程中更积极主动，鼓励病人说出自己的症状并且询问医生：“这还会是什么病？”凯泽永久的一个试点项目为病人提供小册子，鼓励他们思考并写下自己的症状以及他们的担忧或恐惧，鼓励他们提出具体的问题，从而确保他们理解自己的诊断结果以及下一步需要采取的步骤。

Medical schools, meanwhile, are teaching doctors to be more receptive to patient input and avoid 'anchoring,' the habit of focusing on one diagnosis and excluding other possible scenarios, and 'premature closure,' not even considering the correct diagnosis as a possibility.
与此同时，医学院也在教导医生们更加虚心听取病人的意见并避免“锚定”，即习惯集中在一种诊断上，不考虑其他可能的情形，还要避免“过早下结论”，即根本不把正确诊断作为一种可能性进行考虑。

The Critical Thinking program at Dalhousie University in Halifax, Nova Scotia, established last year, aims to help trainees step back and examine how biases may affect their thinking. Developed by Pat Croskerry, a physician known for his research on the role of cognitive error in diagnosis, it uses a list of 50 different types of bias that may lead to diagnostic error.
加拿大新斯科舍省哈利法克斯(Halifax)的达尔豪斯大学(Dalhousie University)去年创立了批判性思考项目。该项目旨在帮助学员退一步思考，审视偏误会对自己的思维有何影响。该项目由帕特・克罗斯克里(Pat Croskerry)开发，他是一名以研究诊断过程中认知错误的影响而闻名的医师。项目列出了50种不同种类可能导致诊断失误的偏误。

The program is being integrated throughout four years of the medical school. Students study cases such as a psychiatric patient with shortness of breath who was assumed to be merely having an anxiety attack; doctors overlooked that she was a smoker on birth-control pills, a risk for the blood clot that later traveled to her lung and killed her.
该项目被整合到了达尔豪斯大学医学院的四年制教学中。学生们会学习很多案例，比如呼吸短促的精神病人被认为只是焦虑发作，医生没注意到她是服用避孕药的吸烟者，这导致她体内产生血块，随后血块到了肺里，最终令她丧命。

'If we can teach physicians how to think more critically,' Dr. Croskerry says, 'they would be more effective in delivering good care and arriving at the right diagnosis.'
克罗斯克里博士说：“如果我们教会医生们如何以更批判性的思维思考，他们就会更有效地给病人看病并做出正确诊断。”