A comprehensive model of clinical decision making

Accountability in health care delivery requires that the ratio of patient benefits to patient costs be maximized. This goal is achieved by optimizing patient outcomes, expressed in terms of the degree to which discomfort and dysfunction are alleviated. To achieve this goal it is necessary to understand how diagnostic problem solving and clinical decision making under conditions of uncertainty are best carried out.

This paper synthesizes several studies of clinical problem solving and decision making into a coherent and comprehensive descriptive model.

This model should serve as a framework within which the more specific quantitative techniques necessary for optimizing patient outcomes can be developed. The ongoing development of such a model has profound implications not only for clinical practice but also for the education of clinicians and for clinical research.