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This study reports on physicians' processing of probabilistic information while they were treating possible pneumonia patients at an outpatient clinic. Physicians overestimated the patients' probability of pneumonia but were sensitive to relative differences in the predictive value of symptoms when present and absent, and appeared to use base-rate information correctly when making clinical judgments.

This paper discusses the measurement of patients' values for future outcomes and examines some problems clinicians confront when making management decisions that attempt to comply with those values. It presents a model that implies that a patient's preference varies with the passage of time, and that during certain periods of time a patient's values may not be representative of his or her long-term preference. An examination of the attitudes of 18 pregnant women toward avoiding pain and avoiding anesthesia bore out the predictions of this model. The women preferred to avoid using anesthesia during childbirth when asked one month before labor and during early labor; however, during active labor their preferences suddenly shifted toward avoiding pain (p less than 0.05). Their preference shifted again toward avoiding the use of anesthesia (p less than 0.05) when evaluated at one month postpartum. The women's preferences one month before labor were the best predictors of their postpartum preferences. The women's preferences during active labor and transition phase of labor were unrelated to their postpartum preferences. These results suggest that, depending upon when a patient's values are measured, (1) they may not be representative of his or her long-term preference, and (2) their use in decision analyses may not maximize the patient's long-term satisfaction so much as they maximize the probability that the decision will be based on the patient's impulsive response. These results also imply that (3) patients may make inherently less reliable value assessments of abstract outcomes they have never experienced, and (4) the distinction between current and long-term values can create a problem when determining whether people behave rationally.

This assumption follows from, but is not dependent upon the following two conditions: (a) all zs above some c (e.g., 1.96) are reported in the literature, and (b) all reports in the literature contain zs above some c (e.g., 1.96).Condition b appears to be reasonably accurate (e.g., 37 of the 42 studies we reported have zs above 1.96). Condition a is probably not very accurate because studies can be rejected for reasons other than small zs.

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