Abstract
A number of workers in Artificial Intelligence have argued that, for some medical domains, critiquing the users decisions is an appropriate approach. Others have stressed the importance of integrating decision-support systems with existing information systems. Little research, however, has been directed to the issues of what consists a relevant critique and whether such a critique could be generated using data obtained from automated medical records. We therefore performed a study in which a general practitioner (GP) was asked to provide us with the computer-based medical records of five patients with hypertension. A printout of these medical records was submitted to an internist who had a recognized interest and experience in the treatment of hypertension. The internist was asked to comment on the treatment of the hypertension as documented in the medical records. Subsequently the comments of the internist were submitted to a panel of three GPs; these GPs were asked to judge the relevance of the comments. Finally the comments of the internist were shared with the GP who had treated the patient.
The internist generated 48 comments. When the GPs were asked to judge the comments of the internist, over 50 percent of these comments were judged relevant — but there was little consensus among the GPs regarding which comments were the relevant ones. The GPs were asked to state why a given comment was not relevant. Over 90 percent of their reasons fell into the following three groups: (a) the GP disagreed with the advice, (b) the GP agreed with the principle but he would prefer to modify the recommendation to suit his practice setting or (c) the GP felt that the advice had no consequence for the decision he had to make, although he did not disagree with the underlyingprinciple. The treatingphysician judged over 50percent of the internist’s comments relevant. The predominant reason given by a treating physician for judging a comment to be irrelevant or less relevant was a misunderstanding of his intentions and/or reasoning by the critiquing physician.
This paper is an extended version of a paper that appeared in MEDINFO 89 under the title “Critiquing Expert Critiques”.
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van der Lei, J., Westerman, R.F., Boon, W.M. (1991). Evaluating Expert Critiques. In: Talmon, J.L., Fox, J. (eds) Knowledge Based Systems in Medicine: Methods, Applications and Evaluation. Lecture Notes in Medical Informatics, vol 47. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-08131-0_9
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DOI: https://doi.org/10.1007/978-3-662-08131-0_9
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