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La certeza diagnóstica

Authors: J Hernández-Clemente; Francesc Borrell Carrió;

La certeza diagnóstica

Abstract

espanolEl proposito de este articulo es profundizar en como tomamos decisiones clinicas satisfactorias ante escenarios de incertidumbre. En la practica clinica aplicamos reglas de decision para estimar grados de certeza y adecuar nuestra conducta. La certeza es un “saber que hacer” frente a la perplejidad o la duda, con un componente epistemico y otro emocional. El saber experto es un saber basado en criterios que se estructuran de manera probabilistica para minimizar el riesgo. La mayor parte de situaciones clinicas finalizan con un calculo de beneficios concreto para esta situacion clinica y este paciente, un calculo que requiere esfuerzo cognitivo. Identificamos diversas estrategias para simplificar este esfuerzo, conducentes a mayores tasas de errores diagnosticos, y defendemos que demorar el diagnostico, (darnos tiempo) es una de las habilidades fundamentales del buen clinico. EnglishThe purpose of this article is to examine how we make decisions in problematic scenarios. In clinical practice we apply decision rules to estimate degrees of certainty and adapt our behavior. Certainty is a "what to do" in front of perplexity or doubt, with both epistemic and emotional component. The expert knowledge is a knowledge based on criteria that are structured in a probabilistic manner to minimize risk. Most clinical situations end with a concrete risk calculation for this clinical situation and this concrete patient, a calculation requiring cognitive effort. We identified several strategies to simplify this effort, which lead us to higher rates of misdiagnosis, concluding that to delay diagnostics, giving us more time to think, is one of the fundamental skills of a good clinician.

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citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
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