Clinical Vs. Actuarial Judgment

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Judgment is a cognitive process. In simple terms, judgment is the process we use to come to a decision or draw conclusions. It entails the ability to shrewdly assess a situation and draw sound conclusions. Because judgment is highly personal, there are different kinds. A person uses objective facts to reach a judgment, but he also uses his prior experiences and knowledge. These vary from person to person.

Diagnoses and Predictions

  • Clinical judgment and actuarial judgment are different methods of handling decision-making in the medical field. When a psychiatrist must decide whether psychotherapy is enough for an ill patient, or whether to also prescribe a drug -- even at the risk of unpleasant side effects -- she has two contrasting methods of decision-making at her disposal. The doctor can approach the problem using her clinical judgment, or by using her actuarial judgment.

Clinical Judgment

  • Clinical judgment requires the doctor -- generally a psychiatrist, physician, or psychologist -- to process the data in his head. Margot Phaneuf, R.N., Ph.D., says that accurate clinical judgment "requires both intellectual and professional maturity." This is because the results can be highly subjective. The professional making the judgments should have prior training, which enhances his understanding of the subject at hand. The advantage of clinical judgment is that the professional may have knowledge of local health phenomena -- for instance, cancer clusters -- that aids with diagnoses. Clinical judgment also has the advantage of including rare events that may not be included in an actuarial formula.

Actuarial Judgment

  • The actuarial, or statistical method, is more objective. In the words of Dawes, Faust and Meehl: "The human judge is eliminated and conclusions rest solely on empirically established relations between data and the condition or event of interest."

    For example, mental health professionals, in particular, are often called upon to try to predict future violent behavior. For many years, up to the 1980s, it was assumed this was not possible. Today's actuarial methods disprove this, and since the 1990s mental health professionals have been able to predict violent behavior with clearly better than chance accuracy.

Which is Better?

  • Actuarial judgment has long been used in such areas as the setting of insurance rates, and is generally recognized to be the more accurate and objective of the two methods. According to Douglass Mossman, M.D, "when it comes to making predictions, clinical judgment -- making predictions by putting together information in one's head -- often is inferior to using simple formulae derived from empirically demonstrated relationships between data and outcome." Dawes, Faust and Meehl confirm, stating that "human decision-makers are not perfectly reliable."

References

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