从耳鼻咽喉科误诊病例谈临床思维

Discussion on Clinical Thinking in Terms of Misdiagnosis of Otorhinolaryngology

临床误诊误治的原因是多方面的，而医师错误的思维方法是主要原因之一，在很大程度上关系着诊断的正确与否。通过数例耳鼻咽喉科典型病例分析，发现导致思维错误的原因有：仅认同表面现象，不能透过现象看本质；一种思维倾向掩盖另一种思维倾向，形成思维定势；主观臆断，不依据客观实际病情做诊断；迷信仪器设备等。因此，临床思维必须坚持辩证法和全面分析的原则，诊断疾病时应做到病史与体检相结合、宏观与微观相结合、临床所见与各种实验检查结果相结合。

There are various reasons for clinical misdiagnosis and mistreatment. Physician's wrong thinking is one of the main reasons. Mode of thinking is very important to the correct diagnosis to a great extent. On the basis of dada from a number of otorhinolaryngologic cases, the authors summarized the causes leading to wrong thinking as the following: being uncapable of seeing through the appearance to the essence; concealing one thinking with another; fixed mode of thinking; a subjective approach to diseases; blind faith in equipment and so on. Therefore, a principle of dialectics and analysis in all- sided way must be adhered. When making a diagnosis, we should manage to combine case history with physical examination, microcosmic with macrocosmic and clinical findings with laboratory test results.