从伤寒误诊病例谈诊断思维的偏差

Discussion on errors in diagnostic thinking in view of misdiagnosed cases of typhoid fever

临床误诊误治的原因是多方面的 ,而医师思维方法的偏差是其中主要原因之一。通过对伤寒误诊病例的分析 ,提出导致思维偏差的原因有 :重视现象、忽略本质 ,迷信权威 ,静止和局限性的诊断思维 ,过份依赖辅助检查 ,轻视病史询问、满足已知诊断等。因此 ,临床思维必须坚持辩证唯物主义的认识论 ,以客观、全面、深入、发展的观点 ,把握反映疾病本质的特征 ,正确评价各项检验结果 ,综合分析病情资料 ,才能及时纠正错误的临床诊断思维。

Causes for clinical misdiagnosis and mistreatment are many and varied. An error in doctor's mode of thinking is one of the main causes resulting in misdiagnosis and mistreatment. It determines to a great extent whether or not the diagnosis is correct. From analysis of five misdiagnosed cases of typhoid fever, we drew the following causes for errors in thinking: thinking highly of the appearance while neglecting the essence; having blind faith in authority; thinking statically and in one sided; excessively relying on accessory examinations; underrating the history taking and being satisfied with the known diagnosis . Therefore, when considering clinical thinking we must adhere to the dialectical materialist theory of knowledge, seeing through the phenomena the essence of the disease objectively and all sidedly with an eye on the course of its development. Various laboratory test results and the materials about the cases should be evaluated comprehensively. In this way errors in the mode of thinking could be corrected and eliminated.