Mammography and decision making

A little history for the non-US readers: the U.S. Preventive Services Task Force (USPSTF) is an independent panel that reviews evidence and issues recommendations for preventive health care services. They are sponsored by the U.S. Agency for Healthcare Research and Quality (AHRQ) but the panelists are physicians, nurses, and public health researchers employed by universities […]

Symposia from SJDM/SMDM online

The 2008 annual meetings of the Society for Judgment and Decision Making (SJDM) and the Society for Medical Decision Making (SMDM) included a “symposium exchange”. A symposium by SJDM members was presented at SMDM 2008 (Pennsylvania, PA) and a symposium by SMDM members was presented at SJDM 2008 (Chicago, IL). At least one of the […]

Evidence-based diagnosis

I’m writing from Philadelphia, at the annual meeting of the Society for Medical Decision Making. I’ve just had the pleasure of attending a great short course entitled “How to discuss evidence-based diagnosis with experienced clinicians (and avoid giving EBM at bad name)”, taught by Tom Newman and Mike Kohn from UCSF.

Comparative effectiveness and evidence-based medicine

A strange commentary in the Washington Times this week entitled “‘Evidence-based’ Rx miscues” makes claims about evidence-based medicine (EBM): both what the terms means and what it implies for health policy. The author suggests that EBM is equivalent to “one-size-fits-all” medicine that removes physician autonomy in pursuit of a “political imperative to cut costs – […]

Apples, Cheese, and Nudges

“Buy on apples, sell on cheese” is an old proverb among wine merchants. Taking a bite of an apple before tasting wine makes it easier to detect flaws in the wine, and the buyer who does so will not as easily make the mistake of paying more than the wine is worth. Cheese, on the […]

Two stories about testing

A bit of synchronicity strikes, as I come across two different pieces from quite different sources on the question of “even if we have a test that provides probabilities of future health states, do we really want to know?” The first is journalistic. National Public Radio’s program Talk of the Nation did a segment on […]

Developing diagnostic tests

In many clinical decisions, the most ready source of additional information is diagnostic testing. Diagnostic tests include not only laboratory tests, but other sources of information about diagnosis, such as history and physical examination. Patients (and indeed, many physicians), however, do not understand how diagnostic tests are developed or how to determine the value of […]

Information-seeking and its pitfalls

One major strategy for managing uncertainty is seeking additional information about the likelihood of outcomes. New information may enable a patient to reduce their uncertainty directly, as when new research studies provide more insight into patient outcomes and suggest increase the likelihood that a particular treatment will or will not be beneficial. Even when new […]