判断与决策
1.Life is short and art is long; the crisis is fleeting, experience risky, decision difficult.
—— Hippocrates, 460——377 BC
【译文】生命短暂，医路漫漫；生死关头稍纵即逝，经历风险，决策艰难。
2.If we go into a court of law, we see the bench occupied by the learned judges ...and a jury ...what are they met to decide? Perhaps a matter of money or succession.Even if it should be a criminal court, what a contrast have we with the situation of a surgeon on whose single decision the life of a fellow creature depends ...The surgeon cannot lean upon the judgment of others ...He has to examine all the evidence, often strangely perverted; he must judge, unaided by friendly counsel ...a thing of the greatest difficulty.
—— Charles Bell, 1774——1842
【译文】如果我们走进法庭，你会看到法官席上坐满了博学的法官……还有陪审团……他们要做什么决定呢？也许只是钱或继承权问题，即使是刑庭，也和我们外科医生所面对的情况有极大的差别。外科医生的一个决定就左右着其同类的生命存亡……外科医生无法依赖他人的判断……他必须检核所有证据，常常是有些蹊跷的证据；在没有顾问的友好帮助下他必须独自做出判断……这是天大的难事。
3.It is the surgeon himself who must take the final decision, and in making it he necessarily stands apart from his colleagues in a kind of loneliness.
—— Lan Aird, 1905——1962
【译文】做最后决定的是外科医生自己，他必须远离同事的影响在一种孤独的（心理）氛围中做出决定。
【点评】都说外科的工作性质是团队作战，但有多少人理解外科医生“一只孤狼”的这一面呢？或许正因为外科团队作战的性质决定了必须有一位决策者来组织这个团队的行动，从而突显了决策者的重要与孤独。
4.Shakiness of the hand may be some bar to the successful performance of an operation, but he of a shaky mind is hopeless.
—— William Macewen, 1848——1924
【译文】诚然，手抖会在一定程度上影响手术的出色表现，但头脑摇摆不定更令人绝望。
5.Judgement is a great asset; it makes the diagnostician and surgeon both supermen.
—— Charles H.Mayo, 1865——1939
【译文】判断力是一笔巨大的资产，它能让诊断专家和外科医生都成为超人。
6.Surgical judgement is the crowning attribute of a great surgeon since it is always acquired, with much labour and over a long time yet, when acquired, it can be shared with and to some extent imparted to others who are prepared to subject themselves to a similar discipline.Judgement means the making of right decisions.
—— William Heneage Ogilvie, 1887——1971
【译文】外科判断力是一个伟大外科医生最重要的品质，因为它的获得往往需要花费大量的劳动，还有漫长的时间。然而，一旦获得，就可与那些准备从事相同专业的同行分享，并在一定程度上传授给他们。所谓判断力就是做出正确决策的能力。
7.Real surgeons do only what is necessary; only jerks fortify their faltering egos with layers of unnecessary steps: another CT, another consultation, another blood test, another week of AB, another 20 liters of lavage, another 2 units of blood transfusion, another liter of bloodletting, another two drains.
—— Moshe Schein
【译文】真正的外科医生只做必要的事。只有蠢货才会用一个又一个的不必要的步骤来强化犹豫不决的自我：再做一次CT，再会诊，再验血，再用一周抗生素，再灌洗20升，再输2个单位血，再放血1升，再引流2次。
8.Poor judgment is responsible for much bad surgery, including the withholding of operations that are necessary or advisable, the performance of unnecessary and superfluous operations, and the performance of inefficient,imperfect, and wrongly chosen ones.
—— Charles F.M.Saint, 1886——1973
【译文】许多糟糕的手术都归咎于错误的判断，包括取消了必须做或建议做的手术，做了不必要和多余的手术，以及无效的、有缺陷的、甚至错误的手术。
9.The supreme surgeon uses his supreme judgment to avoid situations that would test his supreme abilities.
【译文】超级外科医生用他的超级判断力来避免那些考验他超级能力的情况发生。
【点评】高手总能将危机化解于未然。
10.It is preferable to use superior judgment to avoid having to use superior skill.
【译文】最好用你高超的判断力去避免不得不用的高超技能。
11.Judgment is not the act of making a snap decision.Judgment is like playing chess ...You need to think three or four moves ahead.
【译文】判断不是一个草率的决定。判断就像下棋……你需要提前考虑三四步。
12.For every problem there is one solution which is simple, neat and wrong.
—— Henry Louis Mencken, 1880——1956
【译文】每一个问题，都有一个简单、易行的解决方案，但往往是错误的。
13.Intuition is the fastest way to reach a wrong solution.
—— Dick van Geldere
【译文】直觉，是通往错误方案的捷径。
14.Believe half of what you see and nothing of what you hear.
【译文】所见信一半，道听途说莫理睬。
15.The truth is that surgical decision-making is based on the marriage of evidence from clinical studies, inferences from biology, and the elusive element of surgical experience.
—— John Marshall
【译文】坦率地说，外科手术决策是临床证据，生物学推断和难以捉摸的外科经验的完美结合。
16.When common sense interferes with a protocol, follow common sense.(https://www.daowen.com)
—— Leo A.Gordon
【译文】当常识与规约冲突时，请遵循常识。
17.In the overwhelming majority of instances a therapeutic decision was arrived at in direct relation to what happened in the last similar case the doctor was familiar with.
—— Lucien L.Israel
【译文】 绝大多数情况下，治疗决策的形成往往会直接受到该医生处理上一个类似病例的影响。
【点评】 这种影响有正面的也有负面的。
18.Don't throw away all the wisdom you have because of the last case you have seen.
【译文】不要因为上一个病例的经验而抛弃了你全部的智慧。
【点评】这就是上一个病例带来的负面影响。
19.If you are not sure, it isn't.
—— Mark M.Ravitch, 1910——1989
【译文】如果你不肯定，那就不是。
20.Judgment moderates the response to recognized categories.
—— Charles M.Abernathy, 1941——1994
【译文】判断力能调整对常规套路的反应。
21.Physicians vary in their attitude to surgery.Some regard the avoidance of an operation as an end in itself, and this may not be really in the patient’s interest.
—— Geoffrey Keynes, 1887——1982
【译文】医生对手术的态度各不相同。有些人认为避免手术本身就是目的，而这可能并不真正符合患者的利益。
【点评】目的不是避免手术而是让患者获益。
22.Extreme remedies are very appropriate for extreme diseases.
—— Hippocrates, 460——377 BC
【译文】极端疗法非常适合于极端疾病。
23.It is wiser to attempt a doubtful remedy than to condemn the patient to certain death.
—— Celsus, 25 BC——50 AD
【译文】尝试一种不确定的疗法要比判处患者死刑更明智。
【点评】当下对不少晚期肿瘤患者的试验性治疗就是如此。
24.It is more difficult to decide when not to operate than when to operate and what operation to perform.
【译文】决定何时不做手术比决定何时手术、做什么手术更难。
25.A good surgeon is a doctor who can operate and knows when not to operate.
—— Theodor Kocher, 1841——1917
【译文】一个好的外科医生不仅会做手术，并且要知道什么时候不做手术。
26.The most important decisions in surgery concern operations, whether they shall be done, when they shall be done, and what form they should take.In most operations there is only one best time, and often that best time is reached or passed before a diagnosis can be made ...
—— William Heneage Ogilvie, 1887——1971
【译文】外科最重要的决定都与手术相关，是否应该做，何时做以及怎么做。大多数情况下只有一个最佳手术时机，而且通常在明确诊断之前就已呈现出了最佳手术时机或者已错过最佳手术时机……
【点评】尤其面对一些急诊或疑难危重症患者如何把握这稍纵即逝的最佳手术时机是对外科医生最大的考验。
27.The hardest thing about being a surgeon is knowing when not to do something.Some people don't understand that, but it is the most important thing.The natural tendency is, of course, to do something, to take action.It really comes down to judgment, which most people don't think of as a surgical skill.
—— Norman M.Kenyon
【译文】一名外科医生最难的是知道什么时候不该做什么。有些人不明白这一点，但这是最重要的。通常的思维倾向是要做点什么、采取行动，实际这都归结于一个判断力问题，但大多数人并不认为判断力是一种外科技能。
28.The surgeon whom I would select to tend my family must first know when not to cut, when and where to cut , how to cut, and when to stop cutting.
—— Charles W.Mayo, 1865——1939
【译文】我为家人挑外科医生的原则是，首先他必须知道啥时候不能切、啥时候该切，在哪儿切、如何切，以及何时终止手术。
29.Know what you will do in the event you don’t know what to do.
—— Rick Paul
【译文】要知道在你不知道该做什么的时候你应该做什么。
【点评】上面几句虽然说的都是同一个意思，但我还是不嫌重复的都罗列在此，目的只是想说明，这个老生常谈的简单道理被许多大师反复强调过。