Reference Reviews

Lawrence Looks at Books

Encyclopedia of Medical Decision Making, edited by Michael W. Katten and Mark E. Cowen. 2 vols. 1,229p. Thousand Oaks, CA: Sage, 2009. 978-1-4129-5372-6; 2009-4379. $375.

Health care involves a complex of interrelated decision making processes. A doctor must decide upon a diagnosis and a course of treatment. A patient must decide the value of an elective surgery versus continuing discomfort or disability. Parents must choose between a generic drug and brand-name product that has worked before for their child. A child may decide whether to continue life support for a disabled parent. A hospital manager must determine if his facility can adequately provide specific medical services. In an ideal world, all of these decisions would be made with the priority being given to the best possible care for patients. In reality, many factors determine the way medical decisions are made. The training of the doctor, fear, the understanding of the patient and the ability of a family to pay may all affect the treatment options presented and chosen.

This new encyclopedia provides a scientific overview of the factors influencing medical decision making. This includes the identification of the entities and processes involved, as well as the methods of assessing those decisions. Thus, many of the 338 expert-written articles examine the medical decision making process from the point of view of those making decisions, not just patients and doctors, but also medical proxies, insurance companies, government agencies, medical review boards and hospital ethics committees. Special attention is given to accountability, biases, emotion, pain, risk, uncertainty and other psychological factors underlying medical decision making. From the choices of primary care and genetic testing to questions of informed consent and quality of life, the types of decisions that patients and practitioners face are explored. Bioethics, cost-comparison analysis, risk-benefit trade-offs and other bases of making decisions are explained. So too are methods of predicting and measuring medical outcomes. Disability-adjusted life years, patient satisfaction and hospital report cards are just a few of the topics covered. Heavy emphasis also is placed on biostatistics, decision analysis and mathematical models that explore the probability and consequences of medical decisions in the population at large. These may apply to the utility of diagnostic tests and screening programs or the decision making processes. Though written for students and specialists in the health care professions, explanations of technical issues both statistical and medical are made in layman’s terms. The result is a medical encyclopedia that will serve programs in the health sciences as well as such general disciplines as public policy, management, psychology and sociology.