The full content of Annals is available to subscribers

Subscribe/Learn More  >
Ideas and Opinions |

Medical Heuristics: The Silent Adjudicators of Clinical Practice

Clement J. McDonald, MD
[+] Article, Author, and Disclosure Information

From the Regenstrief Institute for Health Care, and the Indiana University School of Medicine, Indianapolis, Indiana. For the current author address, see end of text. Grant Support: By grants HS 07719-013 and HS 08750-02 from the Agency for Health Care Policy and Research; and by grant N01-LM-4-3410 from the National Library of Medicine. Requests for Reprints: Clement J. McDonald, MD, Regenstrief Institute, 1001 West 10th Street, Indianapolis, IN 46202.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_1):56-62. doi:10.7326/0003-4819-124-1_Part_1-199601010-00009
Text Size: A A A

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.





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.