The DOI matches its Crossref record; 1 of the 1 references it cites were found in a registry or an index.
Medical Heuristics: The Silent Adjudicators of Clinical Practice
Abstract
Robust scientific conclusions are too sparse to inform fully most of the choices that physicians must make about tests and treatments. Instead, ad hoc rules of thumb, or "heuristics," must guide them, and many of these are problematic. Physicians extrapolate from the small samples studied by clinical trials to general populations, but they do so inconsistently. Many physicians live by rules that dictate "not treating the numbers," correcting abnormalities slowly, achieving diagnostic certainty, and operating now to avoid "greater" risk in the future. Yet in each case, historical trends or statistical realities suggest either doing the opposite or investing in more discriminating heuristics. The heuristics of medicine should be discussed, criticized, refined, and then taught. More uniform use of explicit and better heuristics could lead to less practice variation and more efficient medical care.
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“Although diagnostic errors may occur when signs of a disease are atypical or absent, diagnostic errors are often attributed to cognitive (e.g., faulty clinical reasoning) and/or systems-related factors (e.g., inefficient processes and poor communication7,9–21).”
From Reducing Diagnostic Errors through Effective Communication: Harnessing the Power of Information Technology (2008) · cites this paper as [15]
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Macmillan, D. (1974) · BMJ · doi:10.1136/bmj.4.5941.415-a · Cited by 7
Cited by
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Systematic Reviews: Synthesis of Best Evidence for Clinical Decisions
Cook, D. J., Mulrow, C. D., & Haynes, R. B. (1997) · Annals of Internal Medicine · doi:10.7326/0003-4819-126-5-199703010-00006 · Cited by 2,184
Diagnostic error in internal medicine
Graber, M. L., Franklin, N., & Gordon, R. (2005) · Archives of Internal Medicine · doi:10.1001/archinte.165.13.1493 · Cited by 1,549
Content-based image retrieval in radiology: current status and future directions
Akgül, C. B., Rubin, D. L., Napel, S., Beaulieu, C. F., Greenspan, H., & Acar, B. (2011) · Journal of Digital Imaging · doi:10.1007/s10278-010-9290-9 · Cited by 388
Heuristic decision making in medicine
Marewski, J. N., & Gigerenzer, G. (2012) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2012.14.1/jmarewski · Cited by 377
Singh, H., Naik, A. D., Rao, R., & Petersen, L. A. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-007-0393-z · Cited by 162
Metadata
- Authors
- McDonald, C. J.
- Affiliations
- Regenstrief Institute (US)
- Corresponding author
- McDonald, Clement J.
- ORCID
- McDonald, Clement J.
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 1996-01-01
- Volume
- 124
- Issue
- 1_Part_1
- Pages
- 56-62
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W1988365736
- Cited by
- 207
- References
- 1
- Citations by year
- 2025: 7 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 10 · 2019: 5 · 2018: 7 · 2017: 5 · 2016: 8 · 2015: 6 · 2014: 5 · 2013: 5 · 2012: 9
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (HS 07719-013, HS 08750-02)
- U.S. National Library of Medicine (N01-LM-4-3410)
- Topics
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- clinical decision-making, clinical judgment, clinical practice variation, diagnostic certainty, overtreatment, treatment underuse, medical education
- MeSH terms
- Clinical Competence, Decision Support Techniques, Drug Evaluation, Humans, Medicine, Research
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