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Full Description
Decision making is the physician's major activity. Every day, in doctors' offices throughout the world, patients describe their symptoms and com plaints while doctors perform examinations, order tests, and, on the basis of these data, decide what is wrong and what should be done. Although the process may appear routine-even to the physicians in volved-each step in the sequence requires skilled clinical judgment. Physicians must decide: which symptoms are important, whether any laboratory tests should be done, how the various items of clinical data should be combined, and, finally, which of several treatments (including doing nothing) is indicated. Although much of the information used in clinical decision making is objective, the physician's values (a belief that pain relief is more important than potential addiction to pain-killing drugs, for example) and subjectivity are as much a part of the clinical process as the objective findings of laboratory tests. In recent years, both physicians and psychologists have come to realize that patient management decisions are not only subjective but also prob abilistic (although this is not always acknowledged overtly). When doc tors argue that an operation is fairly safe because it has a mortality rate of only 1 %, they are at least implicitly admitting that the outcome of their decision is based on probability.
Contents
1 Medical Thinking: An Introduction.- Research in Medical Decision Making: Definitions, Theories, and Methods.- Organization of this Book.- Summary.- 2 The Acquisition of Medical Data.- The Quality of the Data Produced by Diagnostic Procedures.- The Quality of the Data Recorded by Physician—Observers.- The Development of Signal Detection Theory.- Medical Applications of Signal Detection Theory.- Summary.- 3 Evaluating Medical Information.- Probability Revision and Bounded Rationality.- Judgment Heuristics and Biases.- Information Integration.- Summary.- 4 Choosing Actions.- Steps in Risky Decision Making.- A Prescriptive Example.- Structuring the Decision Task.- Assessing the Probability of Outcomes.- Utility Measurement.- Comparing Costs and Benefits.- Summary.- 5 Learning, Feedback, and Decision Aids.- Measuring Doctors's Performance.- Training in Decision Making.- The Nature of Medical Expertise.- Learning from Experience.- Automatic and Algorithmic Decision Making.- Summary.- 6 Interpersonal, Social, and Economic Factors in Medical Decision Making.- Interpersonal and Social Factors in Patient Care.- Economic Aspects of Medical Decisions.- Toward the Future.- Summary.- References.- Author Index.
