Methods in Medicine

Clinicians spend their working lives making decisions. such decisions are usually made in interlocking streams rather than in the discrete circumscribed contexts so beloved of scientists. When the clinician encounters a patient a complex interactive process is initiated in which the clinician searches his memory to match the symptoms and signs indicated by the patient with the complex disease models which he carries in his head. He then makes choices about further questions or tests in order to clarify his understanding of the patient's problem and to formulate a management or treatment plan. In recent years there has been increasing interest in how clinicians make such decisions and a realization that decision-making in clinical medicine is virtually the same as that in many other professional contexts. The scientific study and formal teaching of clinical decision-making is a relatively young discipline. Less than 20 books have so far appeared which take explicit account of the theoretical and experimental decision-making literature in medicine and other related disciplines. This book is a distinctive and important contribution to this growing field. It combines a comprehensive critical analysis of a wide range of relevant philo sophical, statistical, psychological and medical literature with an interesting set of experimental observations of primary care physicians. Dr. Ridderikhoff shows great erudition and wide command of a large reference literature. Dr. Ridderikhoff takes a firmly descriptive rather than prescriptive viewpoint on understanding clinical decision-making.