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Decision making is the physician's major activity. Every day, in
doctors' offices throughout the world, patients describe their
symptoms and com plaints while doctors perform examinations, order
tests, and, on the basis of these data, decide what is wrong and
what should be done. Although the process may appear routine-even
to the physicians in volved-each step in the sequence requires
skilled clinical judgment. Physicians must decide: which symptoms
are important, whether any laboratory tests should be done, how the
various items of clinical data should be combined, and, finally,
which of several treatments (including doing nothing) is indicated.
Although much of the information used in clinical decision making
is objective, the physician's values (a belief that pain relief is
more important than potential addiction to pain-killing drugs, for
example) and subjectivity are as much a part of the clinical
process as the objective findings of laboratory tests. In recent
years, both physicians and psychologists have come to realize that
patient management decisions are not only subjective but also prob
abilistic (although this is not always acknowledged overtly). When
doc tors argue that an operation is fairly safe because it has a
mortality rate of only 1 %, they are at least implicitly admitting
that the outcome of their decision is based on probability."
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