Actually, there is a considerable literature on how physicians and other
health care professionals judge probability (both in terms of diagnosis and
prognosis.) Its hard to summarize, because how we make judgments probably
depends on the situation (the outcome in question, the patient's
characteristics, etc.) but in general:
-physicians are not always very accurate (but sometimes they are)
-in some situations, which may be those in which there is some evidence
about what patient characteristics relate to the outcome of interest,
more experienced physicians may be better than less experienced ones
-it is possible that specific training interventions could improve
how physicians make specific judgments
-using decision aids and combining the judgments from several people
may help
-physicians are prone to cognitive biases and the inappropriate use
of cognitive heuristics
There are a lot of "may's" and other vague terms in there, because although
there are a few studies out now, their number is dwarfed by the number
of possible situations in which physicians may have to judge the
likelihood of some particular outcome.
Some relevant articles appear below, a convenience sample, uploaded from
a talk bibliography. I have many more in my files.
Hope this helps a little....
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Bushyhead JB, Christensen-Szalanski JJ. Feedback and the illusion
of validity in a medical clinic. Med Decis Making 1981; 1: 115-
123.
Dawes RM, Faust D, Mechi PE. Clinical versus actuarial judgment.
Science 1989;243:1668-74.
Dawson NV, Arkes HR. Systematic errors in medical decision
making: judgment limitations. J Gen Intern Med 1987;2:183-7.
MacKillop WJ, Quirt CF. Measuring the accuracy of prognostic
judgments in oncology. J Clin Epidemiol 1997; 50: 21-29
Poses RM, Cebul RD, Collins M, Fager SS. The accuracy of
experienced physicians' probability estimates for patients with
sore throats. JAMA 1985; 254:925-929.
Poses RM, Anthony M. Availability, wishful thinking, and
physicians' diagnostic judgments for patients with suspected
bacteremia. Med Decis Making 1991;11:159-168.
Poses RM, Bekes C, Copare F, Scott WE. The answer to "what are
my chances, doctor?" depends on whom is asked: prognostic
disagreement and inaccuracy for critically ill patients. Crit
Care Med 1989; 17: 827-833.
Poses RM, Anthony M. Availability, wishful thinking, and
physicians' diagnostic judgments for patients with suspected
bacteremia. Med Decis Making 1991; 11: 159-168.
Poses RM, McClish DK, Bekes C, Scott WE, Morley JN. Ego bias,
reverse ego bias, and physicians' prognostic judgments for
critically ill patients. Crit Care Med 1991; 19: 1533-1539.
Shulman KA, Escarce JE, Eisenberg JM, Hershey JC, Young MJ,
McCarthy DM, Williams SV. Assessing physicians' estimates of the
probability of coronary artery disease: the influence of patient
characteristics. Med Decis Making 1992;12:109-14.
Wallsten TS. Physician and medical student bias in evaluating
diagnostic information. Med Decis Making 1981; 1: 145-164.
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