Chapter 7 Applications of Judgment Analysis and Cognitive Feedback to Medicine

Publisher Summary This chapter describes some of the striking results of application of social judgment theory (SJT) to medical judgment. Clinical judgment traditionally has been considered an intuitive process whereby the physician combines patient history, new observations, and test results to form a diagnosis or plan of treatment. Medical judgments are characterized by uncertainty, subtle clues, and soft data. Judgment can be studied in different areas of medicine, the diagnosis, and in management of depression. Judgment in psychiatry is often thought to involve a high degree of the “art” of medicine, and as such, is a fertile ground for studying variation in physician judgment. One of the contributions of social judgment theory to medical judgment research has been to identify factors important to physicians in making clinical decisions. Policy capturing may identify heavily weighted clinical variables that would not have been found had the investigators relied on clinicians self reports. In many judgment settings, it is difficult if not impossible to determine the correct outcome of a given case.

[1]  R S Wigton,et al.  Transportability of a decision rule for the diagnosis of streptococcal pharyngitis. , 1986, Archives of internal medicine.

[2]  R D Cebul,et al.  The accuracy of experienced physicians' probability estimates for patients with sore throats. Implications for decision making. , 1985, JAMA.

[3]  J P Ornato,et al.  Use of clinical findings in the diagnosis of urinary tract infection in women. , 1985, Archives of internal medicine.

[4]  R M Centor,et al.  The Diagnosis of Strep Throat in Adults in the Emergency Room , 1981, Medical decision making : an international journal of the Society for Medical Decision Making.

[5]  J. Gillis,et al.  An analysis of drug decisions in a state psychiatric hospital. , 1981, Journal of clinical psychology.

[6]  J. Gillis,et al.  Drug Therapy Decisions: A Social Judgment Analysis , 1981, The Journal of nervous and mental disease.

[7]  M. Rothert,et al.  Physicians' Judgments About Estrogen Replacement Therapy for Menopausal Women , 1984, Obstetrics and gynecology.

[8]  D M Chaput de Saintonge,et al.  Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinions and the development of 'paper patients'. , 1983, Annals of the rheumatic diseases.

[9]  A. Gittelsohn,et al.  Small Area Variations in Health Care Delivery , 1973, Science.

[10]  C. Joyce,et al.  Clinical judgment in rheumatoid arthritis. III. British rheumatologists' judgments of 'change in response to therapy'. , 1984, Annals of the rheumatic diseases.

[11]  D M Chaput de Saintonge,et al.  Clinical judgment in rheumatoid arthritis. II. Judging 'current disease activity' in clinical practice. , 1983, Annals of the rheumatic diseases.

[12]  R S Wigton,et al.  Modeling decisions to use tube feeding in seriously ill patients. , 1987, Archives of internal medicine.

[13]  R. Dawes,et al.  Linear models in decision making. , 1974 .

[14]  R D Cebul,et al.  The importance of disease prevalence in transporting clinical prediction rules. The case of streptococcal pharyngitis. , 1986, Annals of internal medicine.

[15]  K R Hammond,et al.  Computer Graphics as an Aid to Learning , 1971, Science.

[16]  C. Joyce,et al.  Inability of rheumatologists to describe their true policies for assessing rheumatoid arthritis. , 1986, Annals of the rheumatic diseases.

[17]  T. R. Stewart,et al.  Increasing the Power of Clinical Trials Through Judgment Analysis , 1988, Medical decision making : an international journal of the Society for Medical Decision Making.

[18]  P. Lovie,et al.  The flat maximum effect and linear scoring models for prediction , 1986 .

[19]  A S Elstein,et al.  Differences in Medical Referral Decisions for Obesity Among Family Practitioners, General Internists, and Gynecologists , 1984, Medical care.

[20]  J. Engel,et al.  An Exploratory Study of Physicians' Clinical Judgment , 1988 .

[21]  S. Gabbe,et al.  Decision Analysis of High-Risk Patient Referral , 1984, Obstetrics and gynecology.

[22]  K. R. Hammond Probabilistic functioning and the clinical method. , 1955, Psychological review.

[23]  R. Wigton,et al.  The effect of feedback in learning clinical diagnosis. , 1986, Journal of medical education.

[24]  K. R. Hammond,et al.  An Experimental Study of the Clinical Judgment of General Physicians in Evaluating and Prescribing for Depression , 1981, British Journal of Psychiatry.

[25]  Kirwan,et al.  Clinical judgement analysis--practical application in rheumatoid arthritis. , 1983, British journal of rheumatology.

[26]  D H Hickam,et al.  Teaching medical students to estimate probability of coronary artery disease , 1987, Journal of general internal medicine.

[27]  J. Gillis,et al.  A Cross-National Study of Drug Treatment Decisions in Psychiatry , 1982, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  James Shanteau,et al.  Reducing the influence of irrelevant information on experienced decision makers , 1984 .

[29]  H. Sox,et al.  Clinical prediction rules. Applications and methodological standards. , 1985, The New England journal of medicine.

[30]  R S Wigton,et al.  How Physicians Use Clinical Information in Diagnosing Pulmonary Embolism , 1986, Medical decision making : an international journal of the Society for Medical Decision Making.

[31]  P. Slovic,et al.  Analyzing use of diagnostic signs. , 1971, Investigative radiology.