Decisiones en medicina / Decisions in medicine

RESUMEN

En este trabajo se hace una revisión de los mecanismos mentales que rodean a la toma de desiciones en la prßctica médica. Se anßlizan tres fomas de pensamiento racional.Probabilístico que se funda en la prevalencia de determinades variables que pueden estudiarse formalmente estimado la sensibilidad especificidad y valor predictivo positivo y negativo en forma cualitativa como simples probabilidades. Causal que sirve para contruir modelos mentales anatómicos, fisiológicos o bioquímico que permitan, con los sintomas del paciente, establecer relaciones de causa-efecto. Determinístico que se origina en formas sólidas de conocimiento médico que sirva para, por medio de algoritmos explícitos o implícitos, tomar desiciones sin ambiguedad. Adémas, el médico suele usar para resolver problemas clínicos métodos intuitivos recurriendo a la heurística que es el arte de la adivinación o de la invención certera.SUMMARY: Related with the complex process of decision making in clinical medicine, three reasoning strategies are considered here: probabilistic thinking relies on prevalence of certain clinical variables and is usually expressed in terms of formal calculation (sensivity, specifity and negative or positive predictive value) or as simple like lihood's. Probabilities in clinical diagnosis are particularly employed in the construction of working hypotheses and in the evaluation of the meanig of test results. Causal reasoning is used to construct anatomic physiologic or biomedical models, coherent with clinical findings, that may be effective for the evaluation of working hypotheses. Deterministc reasoning is founded upon rigid rules, derived from personal or gruop knolwledge or experiences, that are expressed as algoritms. For making judgements or decisions under conditions of uncertainty, heuristic was also considered. As an entirely sujective process, heuristic relies on beliefs and intuitions; though it might be effective it use may leas to systematic or predicable errors