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Medical Heuristics: The Silent Adjudicators of Clinical Practice

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