DECISION-MAKING: The Modern Doctor's Dilemma by

DECISION-MAKING: The Modern Doctor's Dilemma

Email this review


The dilemma that French physician Israel (Conquering Cancer, 1978) examines from the viewpoint of his oncology practice is this: once-fatal diseases can now sometimes be controlled or cured--but doctors are still unsure how to treat individual cases. He has two proposals to help improve decision-making--more attention to clinical research and the use of formal decision-theory--and he makes brief reference to many, many cases. But his book is not sufficiently detailed for physicians or educators, and of questionable relevance for general readers: across the board, Medical Choices, Medical Chances (1981, K. 1980, p. 1601), by Harold Bursztajn and others, offers a more systematic and applicable treatment of the problem. One drawback here, indeed, is that Israel writes as if he were discovering the dilemma--and, in particular, the potential value of decision-theory in simplifying and making logical the increasingly complex decisions a doctor makes in daily practice. The theory is itself complicated (and made more so, in medical practice, by the uncertainty that results from the ""opponent"" being nature), and it is not really clarified here: Israel wants to argue for its use, rather than to explain how it's applied. Consequently, the purpose remains unclear to non-physicians, the method to physicians (both of whom, again, will learn more from Bursztajn et al.). Israel does better on the attendant issues: ethical choices in patient care--which would be individualized, he feels, by the decision-theory approach; how such an approach could affect the selection and training of M.D.s. (Do we want logicians with good memories? Scientifically-curious humanitarians? Kindly renaissance sorts?) The issues and possibilities are nicely set out, then; but since organized medicine is already taking the approach seriously (as conferences and journal articles, as well as the Bursztajn book attest), and the general public will have trouble construing it, both the impact and the follow-through are lost.

Pub Date: Feb. 7th, 1981
Publisher: Random House