LETTER
Clinical Judgment
Mark A. Judson, MD
15 October 1994 | Volume 121 Issue 8 | Page 624
TO THE EDITOR:
In his recent article [1], Dr. Feinstein eloquently outlined a subtle but real problem: Physicians are moving away from the patient by proposing that medical problems can be solved by quantitative models rather than by clinical judgment. This attitude has recently been fueled by the national health care debate, which has focused on cost and outcome but not on the welfare of individual patients.
Despite the significant limitations of applying quantitative decision analysis to patient management, I have recently noticed the development of a form of mathematical terrorism: Clinical judgment, even if based on years of experience, knowledge of relevant studies in the medical literature, and the opinions of world experts (usually based on data from more patients with a similar problem than any of us will ever encounter), is rebuked in deference to construction of a quantitative decision analysis.
When faced with a patient who has complex medical problems, I sincerely doubt that results from a quantitative decision analysis will affect my practice. I will continue to use my "clinical judgment," which is not a dirty word.
1. Feinstein AR. Clinical Judgment revisited: the distraction of quantitative models. Ann Intern Med. 1994; 120:799-805.
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