Decision making is a key activity – perhaps the key activity – in the practice of health care. Although physicians acquire a great deal of knowledge and many specialized skills during their training and through their subsequent practice, it is in the exercise of clinical judgment and its application to specific decisions facing individual patients that the outstanding physician is distinguished. This has become even more true as patients have been increasingly welcomed as partners in increasingly complex medical decisions, in what has been termed “shared decision making.”

Medical decision science is a field that encompasses several related pursuits. As a normative endeavor, it proposes standards for ideal decision making. As a descriptive endeavor, it seeks to explain how physicians and patients routinely make decisions, and has identified both barriers to, and facilitators of, effective decision making. As a prescriptive endeavor, it seeks to develop tools that can guide physicians, their patients, and health care policymakers to make good decisions in practice.

Although there have been decades of research and theory on the judgment and decision making of physicians and patients, this “basic science” of the decision process has too often been unknown outside the province of the academic medical center. Just as a substantial crevasse separates the theoretical geneticist from the general practitioner who could benefit from new developments in genetics and genomics, a similar canyon gapes between the decision scientist and the community physician.