Surgical decision making. The reproducibility of clinical judgement
I. M. Rutkow
A considerable portion of negative surgical second opinions may represent
nothing more than reasonable interobserver variation (reliability) among
clinicians. In a previous study, four fictional cases were developed for
each of seven different disease processes. The appropriate case histories
were mailed to a random sample of board-certified surgeons. They were asked
to render a decision on the need for elective operative intervention. This
report presents a two-year follow-up, in which all surgeons who responded
to the original questionnaire were asked to reevaluate the same vignettes.
By comparing an individual surgeon's set of responses, the presence of
intraobserver variation (reproducibility) was noted. The results of this
follow-up showed that a surgeon's judgment with regard to the same
hypothetical elective clinical situation seems to differ over time. If both
the reproducibility and reliability of clinical surgical judgment are as
variable as these studies indicate, then the theoretical premise on which
second-opinion programs are based would seem to be in need of
reexamination.
