Uncertainty of Physicians and Patients in Medical Decision Making

Modern medicine has developed an apparently unlimited array of diagnostic and therapeutic tools; for example, treatment options for patients with hematologic malignancies are expanding rapidly. These developments, offering a spectrum of modalities, provide a new outlook on successful treatment for many patients. Nontheless, decisions regarding the optimum treatment strategy for any individual patient remain challenging, given that all prognostic projections are based on statistics. The challenge lies in identifying parameters that characterize individual patients as prospective responders or nonresponders and thus determine the prognosis. Both physicians and patients are confronted with the uncertainty of the success of treatment with any strategy in a particular disease condition and with the impact of treatment on overall prognosis. How certain can a physician be that an individual patient has the best prognosis with a particular intervention? How does a physician's own uncertainty affect decisions made by a less-informed patient? Here we examine various aspects of uncertainty and their relevance in the process of medical decision making as briefly illustrated by 2 clinical scenarios of hematologic malignancies.