Cargando…

Many faces of rationality: Implications of the great rationality debate for clinical decision‐making

Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' dec...

Descripción completa

Detalles Bibliográficos
Autores principales: Djulbegovic, Benjamin, Elqayam, Shira
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655784/
https://www.ncbi.nlm.nih.gov/pubmed/28730671
http://dx.doi.org/10.1111/jep.12788
_version_ 1783273602931490816
author Djulbegovic, Benjamin
Elqayam, Shira
author_facet Djulbegovic, Benjamin
Elqayam, Shira
author_sort Djulbegovic, Benjamin
collection PubMed
description Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models. Rationality is typically classified under umbrella of normative (addressing the question how people “should” or “ought to” make their decisions) and descriptive theories of decision‐making (which portray how people actually make their decisions). Normative theories of rational thought of relevance to medicine include epistemic theories that direct practice of evidence‐based medicine and expected utility theory, which provides the basis for widely used clinical decision analyses. Descriptive theories of rationality of direct relevance to medical decision‐making include bounded rationality, argumentative theory of reasoning, adaptive rationality, dual processing model of rationality, regret‐based rationality, pragmatic/substantive rationality, and meta‐rationality. For the first time, we provide a review of wide range of theories and models of rationality. We showed that what is “rational” behaviour under one rationality theory may be irrational under the other theory. We also showed that context is of paramount importance to rationality and that no one model of rationality can possibly fit all contexts. We suggest that in context‐poor situations, such as policy decision‐making, normative theories based on expected utility informed by best research evidence may provide the optimal approach to medical decision‐making, whereas in the context‐rich circumstances other types of rationality, informed by human cognitive architecture and driven by intuition and emotions such as the aim to minimize regret, may provide better solution to the problem at hand. The choice of theory under which we operate is important as it determines both policy and our individual decision‐making.
format Online
Article
Text
id pubmed-5655784
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher John Wiley and Sons Inc.
record_format MEDLINE/PubMed
spelling pubmed-56557842017-11-01 Many faces of rationality: Implications of the great rationality debate for clinical decision‐making Djulbegovic, Benjamin Elqayam, Shira J Eval Clin Pract Original Articles Given that more than 30% of healthcare costs are wasted on inappropriate care, suboptimal care is increasingly connected to the quality of medical decisions. It has been argued that personal decisions are the leading cause of death, and 80% of healthcare expenditures result from physicians' decisions. Therefore, improving healthcare necessitates improving medical decisions, ie, making decisions (more) rational. Drawing on writings from The Great Rationality Debate from the fields of philosophy, economics, and psychology, we identify core ingredients of rationality commonly encountered across various theoretical models. Rationality is typically classified under umbrella of normative (addressing the question how people “should” or “ought to” make their decisions) and descriptive theories of decision‐making (which portray how people actually make their decisions). Normative theories of rational thought of relevance to medicine include epistemic theories that direct practice of evidence‐based medicine and expected utility theory, which provides the basis for widely used clinical decision analyses. Descriptive theories of rationality of direct relevance to medical decision‐making include bounded rationality, argumentative theory of reasoning, adaptive rationality, dual processing model of rationality, regret‐based rationality, pragmatic/substantive rationality, and meta‐rationality. For the first time, we provide a review of wide range of theories and models of rationality. We showed that what is “rational” behaviour under one rationality theory may be irrational under the other theory. We also showed that context is of paramount importance to rationality and that no one model of rationality can possibly fit all contexts. We suggest that in context‐poor situations, such as policy decision‐making, normative theories based on expected utility informed by best research evidence may provide the optimal approach to medical decision‐making, whereas in the context‐rich circumstances other types of rationality, informed by human cognitive architecture and driven by intuition and emotions such as the aim to minimize regret, may provide better solution to the problem at hand. The choice of theory under which we operate is important as it determines both policy and our individual decision‐making. John Wiley and Sons Inc. 2017-07-20 2017-10 /pmc/articles/PMC5655784/ /pubmed/28730671 http://dx.doi.org/10.1111/jep.12788 Text en © 2017 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd This is an open access article under the terms of the Creative Commons Attribution (http://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Djulbegovic, Benjamin
Elqayam, Shira
Many faces of rationality: Implications of the great rationality debate for clinical decision‐making
title Many faces of rationality: Implications of the great rationality debate for clinical decision‐making
title_full Many faces of rationality: Implications of the great rationality debate for clinical decision‐making
title_fullStr Many faces of rationality: Implications of the great rationality debate for clinical decision‐making
title_full_unstemmed Many faces of rationality: Implications of the great rationality debate for clinical decision‐making
title_short Many faces of rationality: Implications of the great rationality debate for clinical decision‐making
title_sort many faces of rationality: implications of the great rationality debate for clinical decision‐making
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655784/
https://www.ncbi.nlm.nih.gov/pubmed/28730671
http://dx.doi.org/10.1111/jep.12788
work_keys_str_mv AT djulbegovicbenjamin manyfacesofrationalityimplicationsofthegreatrationalitydebateforclinicaldecisionmaking
AT elqayamshira manyfacesofrationalityimplicationsofthegreatrationalitydebateforclinicaldecisionmaking