3 Review of the literature

In a decision-making situation the individual has two or more choices of action, and from these he can select only one. Decisions are very often based on many attributes or factors, whose individual weights may be very difficult to assess. Another impeding factor is that decisions cannot always be made under conditions of absolute certainty; so-called ’risk decisions’ may be present (6). The decision-making process results in a decision. A decision is a position reached after consideration (7). Examples of medical decisions are diagnosis and treatment. Medical decision-making can be examined from a number of viewpoints. Evans proposes that practising medicine is essentially a cognitive problem-solving activity. If we are interested in understanding this activity, in teaching it or in developing it, we must turn to the cognitive sciences (2). When decision-making is studied from the viewpoint of cognitive science, it is sought to explain what is thinking, problem-solving and so on. Decisionmaking can also be understood as a process that starts with certain initial information and reaches a certain result. Figure 1 represents the wide framework of medical decision-making. The physician makes decisions in all steps and therefore the decisions may vary. In the abridged framework the result of medical decision-making is a diagnosis and treatment a decision made on the grounds of it. Whatever the viewpoint is, the information obtained from the patient’s history always has an effect on the outcome. If the anamnesis is not taken correctly, decision-making will not be successful. It is a significant factor in even the most theoretical approaches to medical decision-making (4).