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Subjectivity in decision making: Common problems and limitations

Abstract

Subjectivity is an inescapable part of the diagnostic and decision making process. Limitations on memory are compensated for by invoking “diagnoses” as devices for managing information during diagnosis. Thus, large amounts of information can be stored as confirmations and departures from the diagnostic hypotheses. Well-documented limitations in probabilistic reasoning interfere with diagnosis and patient management. Uncommon diagnoses may be invoked inappropriately. Misconceptions of chance may lead to erroneous conclusions about health care. Most perplexing is that physicians attempting to incorporate patient preference in decision making are confronted with problems of subjective inconsistencies in patient valuation of outcomes of health care. The major problems of quantification and analysis are amenable to management through education, computing, and better patient data management. Problems of utility elicitation will require further research.

Résumé

La subjectivité fait partie intégrante de l'attitude diagnostique et décisionnelle. Les limites de la mémoire sont compensées par les “suggestions diagnostiques” au cours du processus de recueil des informations à visée diagnostique. Ainsi de nombreuses informations peuvent être stockées pour confirmer ou écarter les hypothèses diagnostiques. Le raisonnement probabliste présente les limites bien connues qui interfèrent avec le diagnostic et le traitement. Des diagnostics rares risquent d'être suggérés à tort. Des conceptions fausses concernant le “hasard” risquent de conduire à des erreurs dans les conclusions dans le domaine de la santé. Un autre fait s'avère plus troublant encore: les mèdecins qui essaient de tenir compte des préférences de leurs patients sont confrontés au problème de l'évaluation subjective des résultats des soins de la part des patients. Les problèmes importants de quantification et d'analyse peuvent être traités grâce à l'éducation, à l'informatique et à une étude meilleure des renseignements des patients. Aucune conclusion ne peut être tirée pour l'instant: il faut poursuivre les recherches.

Resumen

La subjetividad constituye un componente ineludible del proceso de diagnóstico y de toma de decisiones. Las limitaciones de la memoria son compensadas mediante la invocación de “diagnósticos,” o hipótesis diagnósticas, para el manejo de la información en el curso de un diagnóstico. Es así como grandes masas de información pueden ser almacenadas como confirmaciones o como desviaciones de las hipótesis diagnósticas. Bien documentadas limitaciones en el razonamiento probabilístico pueden interferir con el diagnóstico y el manejo del paciente; diagnósticos poco frecuentes pueden ser invocados en forma inapropiada; concepciones equivocadas del azar pueden dar lugar a conclusiones erróneas sobre la atención general de la salud. Causa perplejidad el que los médicos que intentan incorporar las preferencias del paciente en el proceso de la toma de decisiones se ven confrontados con problemas de inconsistencias subjetivas por parte del mismo paciente al emprender la valoración de los resultados de la atención de la salud. Los problemas mayores de cuantificación y análisis son susceptibles de manejo mediante educación, computación, y un superior manejo de la información clínica. Los problemas de deducción de la utilidad requieren investigación adicional.

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Ravitch, M.M. Subjectivity in decision making: Common problems and limitations. World J. Surg. 13, 281–286 (1989). https://doi.org/10.1007/BF01659035

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  • DOI: https://doi.org/10.1007/BF01659035

Keywords

  • Health Care
  • Decision Making
  • Patient Management
  • Como
  • Patient Preference