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June 1986

Decision Making in Gastroenterology

Author Affiliations

Syracuse, NY

Arch Surg. 1986;121(6):732. doi:10.1001/archsurg.1986.01400060130023

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Decision Making in Gastroenterology is a book of annotated algorithms. The author has given a great deal of thought to the structure of these well-conceived decision trees. Numerous gems and a few excellent references are found in the annotations. While the algorithmic method has worked well in the operation and repair of mechanical devices, there are major shortcomings in clinical medicine if too much reliance is placed on this highly structured approach.

Decision Making in Gastroenterology oversimplifies complexities and indicates neither which steps are critical nor at what point a decision is crucial. For example, it has not been shown that a nasogastric tube is essential for the successful treatment of pancreatitis, yet the book states I should use such a tube for severe (but not mild) pancreatitis. It goes on to suggest that I can only determine the severity of the pancreatitis by doing laboratory studies. This approach not

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