Doctors’ Attitudes to Risk in Difficult Clinical Decisions: Application of Decision Analysis in Hepatobiliary Disease
Open accessAbstract
Twelve doctors with special training in hepatology independently reviewed two to five cases each from a group of seven cases of complicated hepatobiliary problems. A doctor's willingness to take risks to improve his patients' health was quantified by a wagering technique based on the probability of achieving a successful intervention. These probabilities were then used to calculate "utilities," which represented the average opinion of the doctors about the relative worth of each of six predefined states of health. The results showed that, in the context of risky decisions for severely ill patients, a year of life was considered by the doctors to be worth 44% of a full recovery; being mobile for that year increased this value to 57%. Survival for up to five years with restricted mobility was considered to be worth 70% of a full recovery and the ability to work during that period increased this value to 85%. It is concluded that in clinical decision making the uncertainty and preferences implicit in a course of action can be quantified and thus made explicit.
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Clinicians' decision making in complex cases mirrors delay discounting, as they balance their perceived best benefits with the relative utility of possible health outcomes to effectively weigh risks and benefits.
“Clinicians’ decision making in complex cases mirrors delay discounting, as they balance their perceived best benefits with the relative utility of possible health outcomes to effectively weigh risks and benefits [111].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [111]
The Introduction describes difficult clinical decisions as weighing the likelihood of intervention succeeding against the relative merits of possible health outcomes. The Calculation of Utilities section formalizes that comparison using probabilities and utilities. The paper does not characterize this process as delay discounting, so that part of the claim is unsupported. (LLM, conf=0.85)
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References 15 · Cited by 6
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- Authors
- Theodossi, A., Spiegelhalter, D. J., McFarlane, I. G., & Williams, R.
- Affiliations
- MRC Biostatistics Unit (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1984-07-28
- Volume
- 289
- Issue
- 6439
- Pages
- 213-216
- ISSN
- 0007-1447 (ISSN-L)
- 1468-5833
- OpenAlex
- W2061626891
- Cited by
- 6
- References
- 15
- Citations by year
- 2026: 1 · 2012: 1
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- clinical decision-making, hepatobiliary diseases, decision analysis, utility analysis, health state preferences, quality of life, risk aversion
- MeSH terms
- Adult, Attitude of Health Personnel, Biliary Tract Diseases, Decision Making, Female, Humans, Liver Diseases, Male, Middle Aged, Physicians, Probability, Prognosis, Risk-Taking
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