Arthur S. Elstein

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  • A S Elstein
  • Academic medicine : journal of the Association of…
  • 1999
Many clinical decisions are made in uncertainty. When the diagnosis is uncertain, the goal is to establish a diagnosis or to treat even if the diagnosis remains unknown. If the diagnosis is known (e.g., breast cancer or prostate cancer) but the treatment is risky and its outcome uncertain, still a choice must be made. In researching the psychology of(More)
BACKGROUND Missed or delayed diagnoses are a common but understudied area in patient safety research. To better understand the types, causes, and prevention of such errors, we surveyed clinicians to solicit perceived cases of missed and delayed diagnoses. METHODS A 6-item written survey was administered at 20 grand rounds presentations across the United(More)
Normative discounted utility theory specifies that the values of all future outcomes (for example, those related to health and money) should be discounted at a constant rate. Two experiments demonstrated that, contrary to this prescription, decision makers use different discount rates for health-related decisions and money-related decisions. Temporal(More)
This paper has five objectives: (a) to review the scientific background of, and major findings reported in, Medical Problem Solving, now widely recognized as a classic in the field; (b) to compare these results with some of the findings in a recent best-selling collection of case studies; (c) to summarize criticisms of the hypothesis-testing model and to(More)
OBJECTIVE To examine the first decade of experience with minimal access surgery, with particular attention to issues of training surgeons already in practice, and to provide a set of recommendations to improve technical training for surgeons in practice. SUMMARY BACKGROUND DATA Concerns about the adequacy of training in new techniques for practicing(More)
Consideration of cerebral arteriovenous malformation (AVM) illustrates how decision analysis may be used to evaluate systematically two treatment options--surgery before bleeding occurs or conservative management. The analysis balances risk of immediate surgical mortality and morbidity against the delayed risks inherent in conservative management. Because(More)