Physicians have pervasive problems in quantitative reasoning. In particular, physicians have difficulty in diagnosis with Bayesian analyses (1-3), interpreting effectiveness of treatments (4,5), and in estimating probabilities (1-2,6-8). Perhaps as a result, physicians infrequently use probabilities in their clinical practice (9-11).
The consequences of these difficulties may include excessive test ordering (12), incorrect interpretation of test results (13), inconsistent interpretation of qualitative descriptions of probability (14), inconsistent interpretration of absolute versus relative risk(15), inconsistent treatment decisions (1), and over-treatment of conditions that have infrequent bad outcomes 20.
Varous solutions have been studied. Several studies have shown clinical improvements when the use of clinical prediction rules were taught to clinicians (15-21), especially when the prediction rules are integrated into patient care as part of the work flow (19-21). Studies of formal shared decision making suggest that patients are less likely to choose options such as prostate cancer screening after being informed of the actual probabilities of outcomes (22). One randomized trail showed that teaching probabilistic reasoning was associated with decrease tested ordering by physicians (11).
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17. Auleley GR, Ravaud P, Giraudeau B, Kerboull L, Nizard R, Massin P, Garreau de Loubresse C, Vallee C, Durieux P. Implementation of the Ottawa ankle rules in France. A multicenter randomized controlled trial. JAMA 1997;277(24):1935-9. PMID: 9200633.
18. Stiell IG, Wells GA, Hoag RH, Sivilotti ML, Cacciotti TF, Verbeek PR, Greenway KT, McDowell I, Cwinn AA, Greenberg GH, et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA 1997;278(23):2075-9. PMID: 9403421.
19. Selker HP, Beshansky JR, Griffith JL, Aufderheide TP, Ballin DS, Bernard SA, Crespo SG, Feldman JA, Fish SS, Gibler WB, et al. Use of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) to assist with triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia. A multicenter, controlled clinical trial. Ann Intern Med 1998;129(11):845-55. PMID: 9867725.
20. Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA. 2000 Feb 9;283(6):749-55. PMID: 10683053.
21. Yealy DM, Auble TE, Stone RA, et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med. 2005 Dec 20;143(12):881-94. PMID: 16365469.
22. Barry MJ. Health decision aids to facilitate shared decision making in office practice. Ann Intern Med. 2002 Jan 15;136(2):127-35. PMID: 11790064.