Internal and Emergency Medicine

, Volume 13, Issue 3, pp 449–451 | Cite as

Understanding and improving decisions in clinical medicine (III): towards cognitively informed clinical thinking

  • Vincenzo CrupiEmail author
  • Fabrizio Elia
  • Franco Aprà
CE - Clinical Notes

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...


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human and animals performed by any of the authors.

Informed consent

Informed consent was obtained from all participants included in this study.


  1. 1.
    Eddy DM (1982) Probabilistic reasoning in clinical medicine: problems and opportunities. In: Kahneman D, Slovic P, Tversky A (eds) Judgment under uncertainty: heuristics and biases. Cambridge University Press, Cambridge, pp 249–267CrossRefGoogle Scholar
  2. 2.
    Hoffrage U, Lindsey S, Hertwig R, Gigerenzer G (2000) Communicating statistical information. Science 290:2261–2262CrossRefPubMedGoogle Scholar
  3. 3.
    Girotto V, Gonzalez M (2001) Solving probabilistic and statistical problems: a matter of information structure and question form. Cognition 78:247–276CrossRefPubMedGoogle Scholar
  4. 4.
    Harris M, Taylor G (2014) Medical statistics made easy, 3rd edn. Taylor & Francis, LondonGoogle Scholar
  5. 5.
    Redelmeier DA, Ferris LE, Tu JV, Hux JE, Schull MJ (2001) Problems for clinical judgment: introducing cognitive psychology as one more basic science. CMAJ 164:358–360PubMedPubMedCentralGoogle Scholar

Copyright information

© SIMI 2017

Authors and Affiliations

  1. 1.Department of Philosophy and Education, Center for Logic, Language, and CognitionUniversity of TurinTurinItaly
  2. 2.High Dependency UnitSan Giovanni Bosco HospitalTurinItaly

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