Analysing how we reach clinical decisions


Edited by Huw Llewelyn and Anthony Hopkins

Diagnosis, followed by effective interventions to achieve outcomes desired by the patient lie at the heart of medical practice. Clinicians do this every day, yet do not make their processes explicit. The probabilities of achieving different outcomes can be ascertained from the research literature. The value attached to the outcomes is, of course, a matter for the patient, but can also be measured.

This book (published in 1993) explains how clinical decision analysis breaks down the processes of decision making into component parts, so that it can be seen how different probabilities of reaching defined outcomes and different patient values placed on those outcomes determine the expected value of different clinical actions.

Each chapter considers the topic using the same illustrated case sample, a patient with a transient ischaemic attack. The chapters illustrate how to set up a decision tree, and the effect of varying the probabilities and utilities upon the expected value of different interventions. The book will be a useful text for all those clinicians who wish to consider in more detail how they reach clinical decisions and how they can make these decisions more explicit and robust. It will also be of interest to all those engaged in health informatics, economics, computing and statistics.

Copies available on request.


  • Medical decision making, clinical judgement and decision analysis - Tim de Dombal
  • Clinical decision analysis: background and introduction - Jack Dowie
  • A case history and some definitions - Huw Llewelyn and Anthony Hopkins
  • The role of Baye's theorem in diagnosis, prediction and decision making - Robin Knill-Jones
  • Analysing the discriminating power of individual symptoms, signs and test results - Mauritzio Koch, Luchio Capurso and Huw Llewelyn
  • A physician arriving at diagnoses, predictions and decisions - Grahame Hankey, James Slattery and Charles Warlow
  • Clinical decision analysis: an application to the management of an elderly person with hypertension who has had a transient ischaemic attack - Jack Dowie, Grahame Hankey and Huw Llewelyn
  • Practical steps in setting up a decision support system - Peter Emerson and Charles Pantin
  • Practical guidelines and bringing the patients into clinical decisions - Anthony Hopkins
  • Estimating utilities for making decisions in health care - Michael Drummond
  • Decision analysis in the context of day-to-day clinical practice - Huw Llewelyn

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