Everyday diagnostics--a critique of the Bayesian model

In recent years Bayesian probability calculus and Bayesian decision procedures have been recommended for use in clinical medicine. The author investigate everyday diagnostics asking if it takes place in a reality that meets the conditions of the method. He finds it does not. Above all we lack that strict randomness essential for probability calculus and, further, evaluation of utility easily becomes disputable, not to say unethical. The measures constructed for neutralizing these discrepancies between model and reality demand great resources. Yet, they are not enough to permit the clinician to refrain from supervising the consequences of his decisions as carefully as he has always done. A different method, a different model is wanted.