Use of formal methods in medical decision making: a survey and analysis

Apparent low usage of formal decision techniques by general clinicians has raised questions about dissemination methods and about the techniques' perceived usefulness. Two literature searches examined whether use of formal decision techniques among clinicians had indeed failed to increase from the 1970s to the 1980s. A general MEDLINE search for the period 1983-87 relative to 1973-77 indicated that usage of formal decision techniques had more than doubled. This increase, however, was due to increased coverage of formal decision techniques in specialist methods journals. A manual search of seven major clinical journals and a MEDLINE search restricted to the clinical journals of the manual search disclosed no increase in overall usage for the same time periods. MEDLINE detected only a small subset of the actual instances of formal method usage found by the manual search. Individual medical subspecialties were found to utilize different formal decision techniques to different degrees. The authors suggest interventions that may increase the usage of formal decision techniques among general clinicians.