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date: 25 January 2020

Abstract and Keywords

Medicine is not a mechanical science. Instead, it is a social science that requires complex decisions based on ambiguous evidence. Uncertainty often exists about the correctness of the diagnosis, regarding whether treatments will make patients better, and regarding variability in beliefs that treatments are safe. This chapter presents evidence showing that substantial variability arises in physician decisions. It reviews several lines of research to demonstrate remarkable variation in the decisions to use diagnostic tests and therapeutic interventions. It argues that physician decisions are influenced by incentives to increase the number of patients receiving a chronic disease diagnoses through aggressive testing and through changes in the definition of what we label as “disease.” These incentives can have substantial impacts on health care costs, patient anxiety, and the organization and delivery of health care. Because of these problems, patients need to be much more active in sharing decisions about their own care. The final section of the chapter reviews the emerging literature on shared medical decision making.

Keywords: Medical decision making, health care decision making, medical diagnosis, patient participation

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