Forecasting, uncertainty and risk; perspectives on clinical decision-making in preventive and curative medicine

Should we screen the population routinely for the presence of breast or prostatic cancer? This simple proposition masks a landscape of complexities, including the economics of screening, the prevalence and probability of the disease, desired frequencies of intervention and a willingness to adopt preventive screening. These ‘risk factors’ form part of a broader landscape of uncertainty that characterises the intricacies of clinical decision-making. Deepening our understanding of the way in which clinicians evaluate risk and uncertainty requires a framing of insights into language, communication, psychology and epistemology. This paper explores perspectives in forecasting and uncertainty as a basis for understanding individuals’ perceptions of risk when assessing their options in both preventative and curative medicine. At the heart of the issue is the prevalence of diagnostic error; this paper argues for the use of systematised approaches to medical error management and inclusive approaches to research in the field. The advantages of augmenting the management of unforeseen consequences through an improved understanding of the issues that are of concern to patients, carers, and medical practitioners alike forms a key construct in this paper. We conclude with an exploration of potential opportunities for improvements in medical practice: changes that may reduce the disbenefits of uncertainty and enhance the management of the general risks associated with clinical decision-making.