Practice variations, appropriateness and decision analysis

摘要

Few would deny that life is a lottery, but the idea that the outcome of medical treatment is also a lottery is only slowly becoming accepted by doctors and patients. For centuries patients have wanted and respected the omnipotent doctor who would make decisions with total certainty, but rising standards of education have generated a healthy lay scepticism about medical activities. The National Lottery is a valuable paradigm for the difficulties of making clinical decisions: patients can accept the idea that some who buy tickets will certainly win, some certainly will not, but that the outcome in any week for an individual is totally unknown and utterly dependent on chance-and so with medical treatment.