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01-04-2018 | CE - Clinical Notes

Understanding and improving decisions in clinical medicine (III): towards cognitively informed clinical thinking

Authors: Vincenzo Crupi, Fabrizio Elia, Franco Aprà

Published in: Internal and Emergency Medicine | Issue 3/2018

Excerpt

Clinical practice is often associated with judgment and with uncertainty, and rightly so. Since the logic of uncertainty is probability theory, understanding clinical judgment requires consideration of how clinicians assess probabilities. Suppose, for instance, that you are involved in a mammography screening program for the early detection of breast cancer. A 50-year-old woman with no symptoms has a positive test result. The pretest probability of breast cancer in her age group is 1%, and the sensitivity and specificity of the test are 80 and 90%, respectively (so the false positive rate is 10%). In light of her positive mammography, what is the probability that your patient actually has breast cancer? …

Meanwhile, other researchers have shown that the frequency terminology is not even necessary to foster accurate responses, as long as the right kind of nested structure is conveyed in the representation of the problem [3].

Eddy DM (1982) Probabilistic reasoning in clinical medicine: problems and opportunities. In: Kahneman D, Slovic P, Tversky A (eds) Judgment under uncertainty: heuristics and biases. Cambridge University Press, Cambridge, pp 249–267CrossRef

Hoffrage U, Lindsey S, Hertwig R, Gigerenzer G (2000) Communicating statistical information. Science 290:2261–2262CrossRefPubMed

Girotto V, Gonzalez M (2001) Solving probabilistic and statistical problems: a matter of information structure and question form. Cognition 78:247–276CrossRefPubMed

Harris M, Taylor G (2014) Medical statistics made easy, 3rd edn. Taylor & Francis, London

Redelmeier DA, Ferris LE, Tu JV, Hux JE, Schull MJ (2001) Problems for clinical judgment: introducing cognitive psychology as one more basic science. CMAJ 164:358–360PubMedPubMedCentral

Title: Understanding and improving decisions in clinical medicine (III): towards cognitively informed clinical thinking
Authors: Vincenzo Crupi
Fabrizio Elia
Franco Aprà
Publication date: 01-04-2018
Publisher: Springer International Publishing
Published in: Internal and Emergency Medicine / Issue 3/2018
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI: https://doi.org/10.1007/s11739-017-1763-0

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