November 13, 1987

Medical Thinking: The Psychology of Medical Judgment and Decision Making

Author Affiliations

Veterans Administration Hospital Hines, Ill

Veterans Administration Hospital Hines, Ill


by Steven Schwartz and Timothy Griffin, 277 pp, with 28 figures, $39, New York, Springer-Verlag NY Inc, 1986.

JAMA. 1987;258(18):2595-2596. doi:10.1001/jama.1987.03400180129049

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There is a wealth of information in this volume on current knowledge about how we actually do, or theoretically might, acquire, evaluate, and make decisions to act on patient-related information in the practice of medicine. The bibliography contains more than 500 citations, beginning in the 1950s and reaching a crescendo in the 1980s.

The case of "Mrs K.," adapted from Harper's magazine, makes a dramatic introduction to these topics. A seriously ill patient, with initially puzzling, multisystem disease, died after 25 days in the hospital after having received 31 roentgenographic examinations, 136 drug doses in addition to IVs, and laboratory studies costing $11000—for a total hospital bill of $47 311. Should her- case- havebeen handled differently to favor a better outcome, cause less discomfort, or reduce cost? Implicit in this question are considerations of gathering and evaluating patient information, deciding what the totality of information at a particular time means