Patients Derogate Physicians Who Use a Computer-Assisted Diagnostic Aid

Hal Arkes — 2008-03-26T00:01:54-00:00

Med Decis Making, Vol. 27, No. 2. (1 March 2007), pp. 189-202.

Objective . To ascertain whether a physician who uses a computer-assisted diagnostic support system (DSS) would be rated less capable than a physician who does not. Method. Students assumed the role of a patient with a possible ankle fracture (experiment 1) or a possible deep vein thrombosis (experiment 2). They read a scenario that described an interaction with a physician who used no DSS, one who used an unspecified DSS, or one who used a DSS developed at a prestigious medical center. Participants were then asked to rate the interaction on 5 criteria, the most important of which was the diagnostic ability of the physician. In experiment 3, 74 patients in the waiting room of a clinic were randomly assigned to the same 3 types of groups as used in experiment 1. In experiment 4, 131 3rd- and 4th-year medical students read a scenario of a physician-patient interaction and were randomly assigned to 1 of 4 groups: the physician used no DSS, heeded the recommendation of a DSS, defied a recommendation of a DSS by treating in a less aggressive manner, or defied a recommendation of a DSS by treating in a more aggressive manner . Results. The participants always deemed the physician who used no decision aid to have the highest diagnostic ability. Conclusion. Patients may surmise that a physician who uses a DSS is not as capable as a physician who makes the diagnosis with no assistance from a DSS. Key words: decision support techniques; diagnosis computer assisted; patient satisfaction. (Med Decis Making 2007; 27: 189--202) 10.1177/0272989X06297391

In defense of clinical judgment ... and mechanical prediction

Jason Dana — 2007-06-11T18:51:23-00:00

Journal of Behavioral Decision Making, Vol. 19, No. 5. (2006), pp. 413-428.

Despite over 50 years of one-sided research favoring formal prediction rules over human judgment, the “clinical-statistical controversy,” as it has come to be known, remains something of a hot-button issue. Surveying the objections to the formal approach, it seems the strongest point of disagreement is that clinical expertise can be replaced by statistics. We review and expand upon an unfortunately obscured part of Meehl's book to try to reconcile the issue. Building on Meehl, we argue that the clinician provides information that cannot be captured in, or outperformed by, mere frequency tables. However, that information is still best harnessed by a mechanical prediction rule that makes the ultimate decision. Two original studies support our arguments. The first study shows that multivariate prediction models using no data other than clinical speculations can perform well against statistical regression models. Study 2, however, showed that holistic predictions were less accurate than predictions made by mechanically combining smaller judgments without input from the judge at the combination stage. While we agree that clinical expertise cannot be replaced or neglected, we see no ethical reason to resist using explicit, mechanical rules for socially important decisions. Copyright © 2006 John Wiley & Sons, Ltd.

CiteULike: Tag actuarial-clinical

Patients Derogate Physicians Who Use a Computer-Assisted Diagnostic Aid

In defense of clinical judgment ... and mechanical prediction