A Framework of Uncertainty in Medical Decision Making

Historically, medical decisions have primarily involved diagnosis and treatment of
symptomatic patients. Increasingly, medical decisions concern uncertain future health states in asymptomatic people. We construct a taxonomy of five medical decision situations that encompasses these wider possibilities. For each, we identify potential sources of uncertainty that should be considered when assessing the degree of belief that a person has, or will have, a condition. Decision trees illustrate the normative structure of each situation. The five decision situations involve: 1) assessing the symptomatic patient; 2) assessing someone for an asymptomatic condition; 3) assessing someone for increased risk of a future condition; 4) simultaneously assessing multiple risks factors for one person; and 5) assessing the individual based only on population membership.