The decision making process in cancer patient care

In recent years, the interdisciplin aryâ€•orâ€•multidisciplinaryâ€•approach to health care has been widely and rightly acclaimed asan important facet of cancer management. But what â€œ¿ dis ciplinesâ€•are involved and what are the objectives of group effort'@How do they achieve their goals'@What logical steps does the physician working alone or in a group take to arrive at decisions? How are interdisciplinary decisions measured and what types of errors are most com mon? Who is responsible medicolegally for multidisciplinary decisions? What methods best insure cost-effectiveness? In order to answer these and similar questions, the medical profession must define relevant and achievable objec tives (formulated with the patient's per ception of need kept in the forefront); develop managerial methods for coor dinating and evaluating interdisciplinary decisions; and form explicit medical logic systems. There is generally adequate time to ef fectively plan for cancer patient care, planning which is itself a logical process requiring coordinated efforts. At present, this decision making process is too often given over to the logic of the computer. Most computer methods now in use, ranging from the simple proce dures of multiple regression to more highly sophisticated statistical and mathematical procedures, were estab lished years ago; they are taken from the textbook and written into computer pro grams with medical data to give a â€œ¿ diag nosis. â€•In the rush to produce such com puter diagnoses, the statisticians, math ematicians, engineers and program mers who usually make the computer pro grams have often overlooked the essen tial elements of the physician's medical logic aswell asthe patient's objectives. In addition, the medical logic employed by every practicing physician is seldom sufficiently detailed to form the basis for computer programming. Of course, a highly trained physician utilizes many logical rules. But the expert often does not learn these rules in explicit form; rather he gains his knowledge through observing, emulating and performing. Through repeated attempts and repeated failures, he finally attains a state of high skill. He is so intent on the subject mat ter during the training period that he is often unaware of the rules formulated in his mind, subconsciously. These rules may be simple or highly complex; it is seldom known, for often they are not evenwellenoughunderstoodtobeeval uated. But rules there must be, or else the expert could not be so frequently cor rect. He may say that a certain phenome non belongs to a certain class simply be cause it looks that way to him; there are certain rules but they are unknown to his consciousness. The problem is to transform these subconscious, â€œ¿ gut feelingâ€•rules into explicit form which canbeanalyzed. The analysis ofmedicallogicisfacili tated by operations research (OR), a formofmanagement logicdeveloped during World War II, which requires Dr. Spratt is the Director of the Cancer Research Center andChief Surgeon at Ellis Fischel State Cancer Hospital, Columbia, Missouri. Dr. Watson is the Chairman of the Biomathematics Section at the Cancer ResearchCenter.