from In Search of Tools to Aid Logical Thinking and Communicating about Medical Decision Making, by M. G. MYRIAM HUNINK, MD, PhD Med Decis Making 2001;21:267–27
“The discussions always seem to go along the same lines: Dr. Smith says that he feels that treatment X is the right thing to do because he recently read a paper that mentioned that X was beneficial; Dr. Johnson counters that X has a substantial risk associated with it, as was shown in the paper published last year in the world’s highest ranking journal in the field, and should therefore not be considered; and Dr. Gray says that given the current limited budget in the department, maybe we should consider a less expensive alternative or no treatment at all. After talking around in circles for about 10 to 15 minutes, with each doctor reiterating his or her opinion and new facts popping up from time to time, the professor of vascular surgery finally stops the discussion, realizing that his fellows are getting irritated because they have work to do. Practical chores are waiting. And so the professor concludes, “Okay. So it seems we should be doing treatment X.” About 40% of those involved in the decision-making process nod their heads in agreement, another 40% start bringing up objections (which get stifled quickly by the fellows who really don’t want an encore), and the remaining 20% of those involved are either too tired or too flabbergasted to respond or are optimizing another goal in life, namely, job security. Does this sound familiar?”
Illustrates how medical experts have the same problems with deliberative decision as everyone else.