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Healthy Skepticism Library item: 20414

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.


Publication type: Journal Article

Wolf FM, Gruppen LD, Billi JE
Differential diagnosis and the competing-hypotheses heuristic. A practical approach to judgment under uncertainty and Bayesian probability.
JAMA 1985 17; 253:(19):2858


Evaluating the same diagnostic information across the plausible competing diagnoses is a practical strategy (ie, heuristic) to guide decision making in the face of uncertainty. The prevalence of use of this competing-hypotheses heuristic by 89 first-year house officers was examined in three simulated patient cases. Results indicated that only a minority (24%) of the house officers selected optimal diagnostic information consistent with this Bayesian heuristic across all three cases. Almost all (97%) of the house officers selecting optimal diagnostic information were able to identify the most probable diagnosis specified by Bayes’ theorem, while only a chance number (53%) of house officers selecting nonoptimal information were able to identify the most probable diagnosis. The competing-hypotheses heuristic is discussed within the context of diagnostic problem-solving models derived from the literature on medical decision making and clinicopathological conference case records. It is suggested that the heuristic, which does not necessitate any mathematical calculations, may be useful as a complement to clinical judgment.

Bayes Theorem Diagnosis, Differential* Humans Internship and Residency Models, Theoretical Problem Solving


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