Decision Making in Health and Medicine. (Book Reviews).

Publisher: Cambridge University Press, 2001

Authors: M. Hunink, P. Glasziou, J. Siegel, J. Weeks, J. Pliskin, A. Elstein, M. Weinstein

Science, and especially evidence-based data, is gradually replacing art in the practice of medicine. No longer can physicians just rely on their intuitive thinking or "feeling" that a treatment modality is better than another. The presently available large body of evidence mandates that physicians make decisions based on evidence. This is made even more imperative by the widespread availability of medical information, the litigious climate, and the changing patient-doctor relationship. Patients nowadays are better educated than patients a few years ago, and they are encouraged to question their physicians and health care providers. Patients no longer blindly accept whatever the doctor says.

A major problem is how to evaluate the evidence presented. The amount of information available has increased exponentially. It is no longer possible for a physician to keep abreast of all current developments in medicine. Generalists and, to a certain extent, specialists are often expected to evaluate clinical trials comparing different treatment regimens. As the difference between medications is often very small, manufacturers use complicated statistical tests to evaluate these differences. Unfortunately, the average clinician's grasp of biostatistics is rudimentary, and few clinicians can fully appreciate the nuances and limitations of many of the tests used. It is easy for a representative from a pharmaceutical company to browbeat a busy physician by using a few select words borrowed from the biostatistic vocabulary.

The book Decision Making in Health and Medicine aims at helping clinicians evaluate information and integrate quantitative evidence-based data and subjective outcome values to make clinical decisions. The 388-page book has 12 chapters. These include elements of decision making in health care, managing uncertainty, choosing the best treatment, valuing outcomes, interpreting diagnostic information, deciding when to test, multiple test results, finding and summarizing the evidence, constrained resources, recurring events, variability and uncertainty, and finally, proactive decision making: a way of life.

The book is well organized and easy to read. The liberal use of examples helps focus the reader's attention and helps translate the discourse into practical patient care. The numerous tables, graphs, and inserts help the reader find specific topics when using the book as a reference. The various exercises listed in the book help consolidate the concepts learned and reassure the reader that important concepts have been mastered. The references help interested readers pursue an in-depth study of the topic. Finally, the CD-ROM accompanying the book makes it very easy to find the information one is looking for. This book is recommended reading for all clinicians