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Medical decision-making is a complex skill that is slowly acquired over the years by healthcare professionals as they deal with patients, observe more experienced professionals and discuss their decisions and the reasons behind making those decisions with their colleagues. 1 2


Recently evidence-based medicine (EBM) and clinical guidelines have been dominating medical decision making.3 The processes involved in making medical decisions are usually informal and they are various frameworks that help to assist healthcare professionals. These frameworks however can be reduced to four principle steps

  • Identifying the problem.
  • Identifying possible alternatives.
  • Development of possible solutions to the problem.
  • Choosing and implementing the best alternative.

There are also various programs that exist to assist in medical decision-making. In the UK, the National Health Service (NHS), has adopted the clinical management advice system, PRODIGY, which was developed by the Sowerby Centre for Health Informatics Newcastle (SCHIN). The guidance provided by PRODIGY is maintained by the National Institute for Clinical Excellence (NICE). NICE is a Special Health Authority within the NHS providing guidance on medicines, equipment, procedures and management of care.

The Society for Medical Decision Making (SMDM) is another organisation that is involved the improvement in the outcomes of clinical decision making and policy formation but principally within the US.


  1. Flaherty, Robert J. [WWW] 5TH July 1999 About Evidence-Based Medicine. http://www.montana.edu/wwwebm/AboutEBM.htm (3RD October 2003).

  2. Degoulet, Practice; Fieschi, Marius. Introduction to clinical Informatics, Chp 4. Springer 1999.

  3. Parker, M. Whither our art? Clinical wisdom and evidence-based medicine. Med Health Care Philos. 2002;5(3):273-80.



International Medical Informatics Association
American Medical Informatics Association
UK Health Informatics Society
British Computer Society Health Informatics Committee
European Federation for Medical Informatics
American Nursing Informatics Association
American Telemedicine Association

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Last Updated: 9 August 2006.

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