Clinical decision analysis in the past and present as well as in the East and West

Abstract

Background: In daily medical practice, there are many decisions to be made; wrong decision-makings may result in serious outcomes for the patient. Even if the outcome appears to be desirable for the physician, it may be undesirable for the patient in the era of patient-centered medicine; we studied clinical decision-making under uncertainty on the basis of the teachings of great names in history and their works.

Methods: We cited the Maxim by the Hippocrates School, the Ojoyoso by Genshin, Zoshi by Toyo Yamawaki, and the Introduction of the Study of Experimental Medicine by Claude Bernard. We evaluated their effects on advances in medical decision-making.

Results: Even earlier than 2000, the School of Hippocrates recognized the difficulty of decision-making, the danger of physician’s experience, and the elusive nature of opportunity. Genshin (a Buddhist priest in the Heian Era) taught people that life is valued as equal to death, being full of agony and pain; comfort is only gained in the paradise after death. Thus, he dramatically changed the order of outcome values. Toyo Yamawaki and Claude Bernard discouraged theoretical or hypothetical approaches in medical science and advocated evidence-based outcome approaches. They contributed to the evolution of surgical research, clinical decision analysis, and evidence-based medicine.

Conclusion: It is not only Genshin and his followers who believe that life is full of agony and pain, and wish that their lives might be better if shortened by sudden Pokkuri death, rather than be prolonged. Physicians should take such wishes into consideration.