Medical Decision Making: A Physician's Guide

Decision making is a key activity, perhaps the most important activity, in the practice of healthcare. Although physicians acquire a great deal of knowledge and specialised skills during their training and through their practice, it is in the exercise of clinical judgement and its application to individual patients that the outstanding physician is distinguished. This has become even more relevant as patients become increasingly welcomed as partners in a shared decision making process. This book translates the research and theory from the science of decision making into clinically useful tools and principles that can be applied by clinicians in the field. It considers issues of patient goals, uncertainty, judgement, choice, development of new information, and family and social concerns in healthcare. It helps to demystify decision theory by emphasizing concepts and clinical cases over mathematics and computation.

Translates the theory from the science of decision making into clinically useful tools and principles.

Doody Review Services

Reviewer:Robert M. Hamm, PhD(University of Oklahoma Health Sciences Center)
Description:This is a thoughtful exposition of the breadth of the medical decision issues to which the analyses of decision theory have often been applied. The authors' approach to medical decision making ensures that readers from different backgrounds understand the concepts by expressing them in words, elaborated with concrete numerical examples and graphs, instead of expecting symbolic formulas to communicate. They state four fundamental beliefs as the focus for the book: 1) basic patterns of decision making are found in the majority of clinical decisions; 2) making good decisions is better than making perfect ones; 3) making clinical decisions requires input from both patients and physicians; and 4) the practice of medicine and healthcare policy are inseparably linked.
Purpose:As medical educators, the authors hope to bridge the gap between decision scientist and community physician. They implement clinical examples to present a version of decision making theory that many readers will find refreshing and helpful.
Audience:This book is aimed at practicing physicians already well down the clinical path, never planning on doing a decision analysis, who want to understand the ideas that have been produced by this field and to appreciate how they are relevant to daily medical practice. Researchers and analysts will find theories in the book appealing, as there is a rich vein of issues needing further study. Other nonphysicians will appreciate the clear exposition of ideas that are, after all, of universal human interest.
Features:The five sections cover the goals of medical care, valuing health, understanding uncertainty, developing information, and issues beyond the individual. Each has two to three chapters discussing different elements of the topic, with case examples. Each topic is covered thoroughly, though at an introductory level. Readers can easily follow and understand the authors' explanations. Although the exposition provides an integrated picture of the field, in fact some of the topics and perspectives are relatively new and are those of the authors themselves.
Assessment:This book has the potential for teaching practicing physicians to make good decisions and to make decisions well. Several books are available that are aimed at teaching medical students or residents the basic mathematics of the fundamental decision analysis techniques, guiding them with formulas, examples, and exercises. This book, in contrast, conveys the ideas through discussion without the technical details. Those wishing to learn particular calculations can use one of these other books or the Encyclopedia of Medical Decision Making, Kattan (Sage Publications, 2009).

Talia B. Magrill, BA, contributed to this review.

Alan Schwartz, PhD, is a decision psychologist in the Departments of Medical Education and Pediatrics at the University of Illinois at Chicago, where he teaches decision making, leadership, and quantitative methods. His research focuses on both patient and physician decision making, including evidence-based medicine, risk perception, and the impact of life goals on utility assessment. He has received the Outstanding Paper by a Young Investigator Award from the Society for Medical Decision Making, the Ray E. Helfer Award for Innovation in Pediatric Education from the Ambulatory Pediatrics Association, and the Junior Faculty Research Award from the Midwest Society for General Internal Medicine. Dr Schwartz serves on the Board of Trustees of the Society for Medical Decision Making, and coordinates the Society's 'Teaching Medical Decision Making' interest group. He also serves on the Executive Board of the Society for Judgment and Decision Making. He has taught leadership and decision making in Brazil and Pakistan, as well as on-line to students throughout the world, and twice received his University's peer-reviewed teaching award.

George Bergus is Professor and Associate Head for Education at the Department of Family Medicine, University of Iowa.