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DECISION ANALYSIS AND DIFFERENTIAL DIAGNOSIS Clinical Decision Analysis The most common, often considered "standard," method of diagnosis practiced by most students, residents, and even experienced physicians, is the "random decision" or "intuitive thinking" method, which does not really follow any conscious methodology. Clinical Decision Analysis or CDA, on the other hand, although not yet studied in a controlled trial showing positive outcome, is based on a step-by-step method of thinking that allows clinicians to advise their patients regarding the "best bet" or "best outcome" for any specific condition. In the same manner that we should wear seat belts, install smoke detectors, recommend car seat for infants and young children, or tell parents to quit smoking, we should use clinical decision analysis in patient diagnosis. CDA keeps the interest of the patient always in the frontal lobes of the clinician. The CDA method starts with treatment considerations such as harm and improvement, followed by testing and diagnosis with its likelihood ratio and pre-test estimation. The reason for thinking of treatment first, then testing or diagnosis afterwards, is that decisions about tests can be properly made after the risks and benefits of a treatment have been critically dissected. With the knowledge and understanding of the risks and benefits, harm and improvement, the clinician and patient can discuss if a test is worthwhile doing. The function of decision analysis, unlike scientific experiment that shows natural truth, is to help a decision maker choose the best option among many alternatives of treatment. Decision analysis does not reduce the uncertainty about the true nature of the patient’s illness, but rather it makes the choices more rational in light of uncertainty. In the long run, if decision analysis is applied in most of the complicated patients, the probability of making a grave error is less compared to the usual "random" or “intuitive” method. | go to top | parent's medical school | archives |
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