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  • Print publication year: 2007
  • Online publication date: December 2014

Medical decision-making

from Psychology, health and illness



Doctors constantly make decisions that affect the health and lives of other people. They gather evidence by interpreting the signs and symptoms of the patient, conducting examinations and determining appropriate tests. All of these actions imply the use of judgement and decision-making. Using such evidence they may form a diagnosis and conclude what, if anything, is to be done. In the current healthcare climate, patients are also encouraged to participate in decision-making, either by sharing in it, or by making their own informed decisions, on the basis of the evidence presented to them by doctors (Charles et al., 1997). Many of these decisions will be based on clear evidence from the patient and tried and tested methods drawn from the doctor's medical knowledge and may seem quite straightforward. However, very often, simple medical principles and rules will not be available. From the perspective of formal Decision Analysis, in order to make an optimal decision, a doctor and patient must identify all the options available, work out their potential outcomes and the probability that these outcomes will occur. They also need to assess how good or bad that outcome occurring would be. Such a process is often difficult for several reasons. Firstly, it is difficult to identify the options and outcomes and their associated probabilities. As the evidence base of medicine develops this may become easier, but where clear evidence about options, or actuarial statistics about their outcomes, are not available doctors have to rely on their judgement.

Charles, C., Gafni, A. & Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science and Medicine, 44, 681–92.
Christensen-Szalanski, J.J.J. (1984). Discount functions and the measurement of patients' values: womens' decisions during childbirth. Medical Decision Making, 4, 47–58.
Christensen-Szalanski, J.J.J., Beck, D.E., Christensen-Szalanski, C.M. & Koepsell, T.D. (1983). Effects of expertise and experience on risk judgements. Journal of Applied Psychology, 68, 278–84.
Cosmides, L. & Tooby, J. (1996). Are humans good intuitive statisticians after all? Rethinking some conclusions from the literature on judgement under uncertainty. Cognition, 58, 1–73.
Dawes, R.M. (1988). Rational choice in an uncertain world. Orlando, FL: Harcourt.
Dawson, N.V. & Arkes, H.R. (1987). Systematic errors in medical decision making: judgement limitations. Journal of General Internal Medicine, 2, 183–7.
Eddy, D.M. (1982). Probabilistic reasoning in clinical medicine: Problems and opportunities. In Kahneman, D., Slovic, P. & Tversky, A. (Eds.). Judgement under uncertainty: heuristics and biases. Cambridge University Press.
Eddy, D.M. & Clanton, C.H. (1982). The art of clinical diagnosis: solving the clinicopathological exercise. The New England Journal of Medicine, 306, 1263–8.
Edwards, A., Elwyn, G., Covey, J., Matthews, E. & Pill, , R. (2001). Presenting risk information – a review of the effects of “framing” and other manipulations on patient outcomes. Journal of Health Communication, 6, 61–82.
Elstein, A.S., Holzman, G.B., Ravitch, al. (1986). Comparisons of physicians' decisions regarding estrogen replacement therapy for menopausal women and decisons derived from a decision analytic model. American Journal of Medicine, 80, 246–58.
Gigerenzer, G. (1994). Why the distinction between single event probabilities and frequencies is important for psychology (and vice-versa). In Wright, G. & Ayton, P. (Eds.). Subjective probability (pp. 129–61). Chichester, UK: Wiley.
Gigerenzer, G. (2003). Reckoning with risk. London: Penguin Books Ltd.
Kahneman, D., Slovic, P. & Tversky, A. (1982). Judgement under uncertainty: heuristics and biases. Cambridge University Press.
Lloyd, A.J. (2001). The extent of patients' understanding of the risk of treatments. Quality in Health Care, 10, I14–18.
Loewenstein, G., Read, D. & Baumeister, D.F. (2003). Time and decision: economic and psychological perspectives on intertemporal choice. Russell Sage Foundation.
McNeil, B.J., Pauker, S.G., Sox, H.E. & Tversky, A. (1982). On the elicitation of preferences for alternative therapies. New England Journal of Medicine, 306, 1259–62.
Meehl, P.E. (1954). Clinical versus statistical prediction: a theoretical analysis and a review of the evidence. Minneapolis: University of Minnesota Press.
Meehl, P.E. (1986). Causes and effects of my disturbing little book. Journal of Personality Assessment, 50, 370–5.
Redelmeier, D.A. & Shafir, E. (1995). Medical decision making in situations that offer multiple alternatives. Journal of the American Medical Association, 273, 302–5.
Ritov, I. & Baron, J. (1990). Reluctance to vaccinate: omission bias and ambiguity. Journal of Behavioral Decision-making, 3, 263–77.
Schwartz, S. & Griffin, T. (1986). Medical thinking: the psychology of medical judgement and decision making. New York: Springer Verlag.
Shafir, E. (1993). Choosing versus rejecting: why some options are both better and worse than others. Memory and Cognition, 21, 546–56.
Simon, H. (1979). How big is a chunk? In Simon, H.A. (Ed.). Models of thought. New Haven: Yale University Press.
Sonnenberg, F.A. & Pauker, S.G. (1986). Elecive pericardiectomy for tuberculous pericarditis: should the snappers be snipped?Medical Decision-making, 6, 110–23.
Stone, E.R., Yates, J.F. & Parker, A.M. (1997). Effects of numerical and graphical displays on professed risk-taking behavior. Journal of Experimental Psychology: Applied, 3, 243–56.
Sumner, W. & Nease, R.F. (2001). Choice-matching preference reversals in health outcome assessments. Medical Decision Making, 21, 208–18.
Timmermans, D., Molewijk, B., Stiggelbout, A. & Kievit, J. (2004). Different formats for communicating surgical risks to patients and the effect on choice of treatment. Patient Education and Counseling, 54, 255–63.
Tversky, A. & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211, 453–8.
Zikmund-Fisher, B.J., Fagerlin, A. & Ubel, P.A. (2004). “Is 28% good or bad?”: evaluability and preference reversals. Medical Decision Making, 24, 142–8.