January 1986

The 'Chagrin Factor' in Obstetrics-Reply

Author Affiliations

New Haven, Conn

Arch Intern Med. 1986;146(1):201. doi:10.1001/archinte.1986.00360130243036

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Although Drs Brody and Thompson seem to agree with most of what was said in the "chagrin factor" paper, they reach some distinctively different conclusions. I proposed an alternative "qualitative" model for making clinical decisions, because it resembles the way many clinicians think, and because the current format of "quantitative decision analysis" requires probability-utility scores that are not customary, accurate, or easy to apply in clinical reasoning. The Brody-Thompson conclusion seems to be that the qualitative approach leads to decisions that are "informally and sloppily" conceived.

Their main argument for this conclusion, however, depends not on the actual mechanism used for clinical decisions, but on the way that clinicians overuse technology in the hope of avoiding chagrin (or high "disutility" scores). The problem of how to deal with chagrin or "disutility" is quite different from identifying what produces it. If we want clinicians and patients to become more tolerant of

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