Two Studies of Good Clinical Judgment

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Abstract
There is a continuing controversy about the quality of unaided clinical judgment. This paper reports two studies that show that experienced medical providers made accurate probability assessments and applied those assessments to patient care in a manner consistent with principles of optimal decision making. In the first study, experienced clinicians and physician assistants accurately judged the relative frequency of three cough-related diagnoses in an outpatient population, suggesting that their encounter with several "unrelated" diagnostic problems does not interfere with their ability to judge accurately the frequency of any single diagnostic problem. In the second study, a group of clinicians assessed the probability that each patient seen in an outpatient clinic had pneumonia. Physicians were more likely to assign a pneumonia diagnosis and to order a radiograph for patients with a greater assessed probability of pneumonia (p less than 0.05). Most of the physicians appeared to use cutoff probabilities or "thresholds" above which they acted as though the patient had the disease and below which they acted as though the patient did not have the disease, consistent with rational decision-making principles. However, the threshold probabilities being used were quite different from physician to physician, implying that the physicians managed the patient population in a nonuniform manner. Thus it may be desirable to supplement "good" clinical judgment with decision aids to ensure standardized medical care.

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