Uncertainty in clinical practice: implications for quality and costs of health care

Logan, Robert L.; Scott, P. J.

doi:10.1016/s0140-6736(96)91284-2

Cited by 106 publications

(56 citation statements)

References 17 publications

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“…It has been commonly asserted that uncertainty is inherent in clinical medicine [1,2]. It has also been argued that our failure to work under uncertainty, or "our stubborn quest for certainty," is the leading cause of excessive diagnostic testing and inappropriate treatments, with a net result in ever-increasing health-care costs [3,4].…”

Section: Introductionmentioning

confidence: 99%

Acknowledgment of uncertainty: A fundamental means to ensure scientific and ethical validity in clinical research

Djulbegoviĉ

2001

Curr Oncol Rep

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Recognition of the importance of uncertainty in the design of randomized, controlled trials (RCT) has reached the status of a principle. The "uncertainty principle," or less ambiguously, equipoise, holds that a patient should be enrolled in an RCT only if there is substantial uncertainty about which of the trial treatments would benefit the patient most. In fact, the "uncertainty principle" addresses the most important issue of a clinical trial--the choice of an adequate comparative control. Studies in which intervention and control group are believed to be non-equivalent violate the uncertainty principle. Therefore, one would expect that both editors and authors would be particularly careful to include a statement concerning prior beliefs of the investigator(s) about the uncertainty of the treatments that are reported. However, we found no evidence of such a policy in the randomized, controlled trials we examined. We also show that there is a predictable relationship between the uncertainty principle, that is, the moral principle upon which trials are based, and the ultimate outcomes of clinical trials. We postulate that about 50% of innovations are successful, leading to the conclusion that preserving the ethics of clinical research may be the best investment strategy available.

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Section: Introductionmentioning

confidence: 99%

Acknowledgment of uncertainty: A fundamental means to ensure scientific and ethical validity in clinical research

Djulbegoviĉ

2001

Curr Oncol Rep

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“…Clinical practice is too complex, multifaceted, deep and situational to be handled by scientific method.' [111] Uncertainty is inherent in clinical practice and a great stress to doctors worried by it: 'Certainty is a delusion -only uncertainty is definite' [112]. To paraphrase Dudley, getting clear answers is easiest when the answers are least needed and hardest when they are most required [113].…”

Section: Resultsmentioning

confidence: 99%

Anaesthesia and evidence‐based medicine

Goodman

1998

Anaesthesia

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“…Examples of disutilities for physicians include regret in missing a potentially fatal condition [11], fear of litigation, and uncertainty [12]. It is difficult to reduce utility to a single unit consistently judged by an external reference standard, making it unlike a unit of length, time, or weight.…”

Section: Utilitymentioning

confidence: 99%