论临床思维的性质和原则

On the Nature and Principles of Clinical Thinking

医学的不确定性的性质和治病救人的目标决定了临床思维的性质与原则。临床思维具有不确定性、概然性、个体性、动态性,因此医生要遵循流程化思维并反复验证自己的临床决策,避免武断下结论和想当然。临床思维的第一原则是“病人安全第一”,实质是“降阶梯思维”,即首先除外威胁病人生命的病症。“首先考虑常见病与多发病”等原则必须以“病人安全第一”为基础;临床思维是“内、外、妇、儿”所有临床专业的思维,遵循临床思维的性质和原则,有助于多学科合作。

The nature of uncertainty of medicine and the goal of saving people's lives determine the nature and principles of clinical thinking. Clinical thinking is uncertain, probabilistic, individual and dynamic. Therefore, doctors must follow medical process and repeatedly verify their clinical decisions in order to avoid arbitrary conclusions and assumptions. The first principle of clinical thinking is the "priority of patient safety", which is essentially a "step-down thinking", solving problems that threaten the patient's life. The principles of "considering common diseases and frequently-occurring diseases first" must be based on "priority of patient safety". Clinical thinking is the thinking of all clinical professions of "internal medicine, surgery, gynecology and obstetrics and pediatrics" and it is conducive to multidisciplinary cooperation.