Formal decision supports in medical practice and education

Abstract

Several formal, quantitative techniques have been developed to help physicians make diagnostic and treatment decisions. Despite the precision of these models, as well as growing documentation of systematic errors in intuitive reasoning, most clinicians choose not to utilize decision supports. This may be due to weaknesses inherent informal models, practical problems implementing them in the clinical environment, or psychological discomfort that arises when physicians try to quantify diagnostic and therapeutic uncertainty or patients’ preferences. An examination of these difficulties, however, does not reveal an adequate basis for rejecting formal decision techniques. Quantitative decision aids can have a positive impact on clinical reasoning and can provide a valuable educational tool for structuring clinical problems. These models can be used to help teach students how to select, structure, and process clinical information. Medical educators now have available models that will enable them to teach several aspects of clinical reasoning rather than rely solely on practice and experience for the development of this important skill.