Our book approaches medical decision making primarily from the standpoint of the community of clinicians, behavior scientists, and theorists who focus on the question of “how should decisions be made in order to provide the patient with the greatest health benefit?” Another group of thinkers, including clinicians, philosophers, lawyers, and patient advocates, have asked an […]
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 […]
Review: Better: A surgeon’s notes on performance, by Atul Gawande
When I was taking my qualifying examinations for my Ph.D. in Psychology, one of my examiners asked me to address what he called the “moon question”: “If human beings are so dumb (according to decision psychology), how did we get to the moon?” The answer, of course, is that despite the predilection in cognitive psychology […]
Confidence
Subjective confidence is usually thought of as the degree to which a person believes they are correct about a judgment and are willing to say so. Confidence can be important when there is no objective guide to accuracy; in these cases, decision makers will usually prefer to make the judgment in which they have the […]
The prediction problem
A major problem in all preference or utility assessment, particularly holistic assessments that require the visualization of a health state in its entirety, is that people must often be asked to assess their preferences for health states that they have not yet experienced. That is, they must predict how they will feel about future health […]
Expectation and preparation
The key rule for evaluating options that include outcomes that are uncertain is the expectation principle: the value of being exposed to the possibility of an outcome is determined by the value of the outcome and the frequency with which it would be experienced if you were exposed to the possibility repeatedly. For example, facing […]
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 […]
Goals and swing weighting
Every guide to decision making emphasizes the importance of goals. Decision makers must clarify their goals when making a decision, lest they make choices that will not serve their ends. To consider alternatives without knowing one’s goals is to let the tail wag the dog. Practically speaking, most medical decision models don’t (and perhaps can’t) […]