Understanding and improving decisions in clinical medicine (III): towards cognitively informed clinical thinking
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Clinical judgment under uncertainty
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?
A problem of this kind represents a crucial fragment of diagnostic reasoning. It involves an uncommon and serious disease, a useful but imperfect item of evidence, and it demands a judgment about the former on the basis of the latter (as a key example...
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Conflict of interest
The authors declare that they have no conflict of interest.
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This article does not contain any studies with human and animals performed by any of the authors.
Informed consent was obtained from all participants included in this study.
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