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  • Clinical vs. Actuarial PDF

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    Surya Saptono Putra
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    9 vues8 pages

    Clinical vs. Actuarial PDF

    Transféré par

    Surya Saptono Putra

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme PDF ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 8
    I Versus Actuarial Judgment Robyn M. Dawes, David Faust, Paul E, Meeh! Science, New Series, Volume 243, Issue 4899 (Mar. 31, 1989), 1668-1674. Stable URL: hup:/Minks jstor-org/sici?sici=0036-8075%28 1989033 1%293%3A243%3A4899% 3C1668%3ACVAIGIE2.0.C¢ ‘Your use of the ISTOR archive indicates your acceptance of ISTOR’s Terms and Cooditions of Use, available at bbtp:/www.jstor.org/about/tenms.htnl. ISTOR’s Terms and Conditions of Use provides, in part, that unless you have obtained prior permission, you may not download an entire issue of a journal or multiple copies of articles, and you may use content in the ISTOR archive only for your personal, non-commercial use. Each copy of any part ofa JSTOR transmi printed page of such transmission, jon must contain the same copyright notice that appears on the sereen or Science is published by American Association for the Advancement of Science. Please contact the publisher for further permissions regavding the use of this work. Publisher contact information may be obtsined at bbtp:sewwjstor.org/joumalsyaass fal Science ©1989 American Association for the Advancement of Science ISTOR and the JSTOR logo are trademarks of JSTOR, and are Registered in the U.S. Patent and Trademark Office. For more information on JSTOR contact jstor-info@unich.edu, ©2002 JSTOR, hup:thrww stor orgy ‘Thu Feb 7 12:21:46 2002 Clinical Versus Actuarial Judgment Roryw M. Dawes, Davip Faust, Paut E, MEEHL Professionals are frequently consulted to diagnose and predict human behavior; optimal treatment and planning often hinge on the consuttant’s judgmental accuracy. The ‘consultant may rely on one of two contrasting approaches, to decision-makin; clinical and actuarial methods. Research comparing these two approaches shows the aerial method te be superior. Factors underlying the greater accuracy of actuarial methods, sources of resi tance to the scientific findings, and the benefits of in- creased reliance on actuarial approaches are discussed. Is this a condivion bese weaced by psychotherapy alone or might ic also requize an ancipsychocie medication with Cecasioally dangerous side effets? Arn elderly pacens complains of iemory los bot neurologic examination and diagrosic studies are juvacal. The neuropsychologist is asked to administer tests 0 help rule out progressive brain disease, A medical work-up confrms 2 ptieae’s worst fare has terminal cancer. He atk the doctor how fang he has co pat is ife i. order “These cree brie seenarios estate 3 few of the many simations in which experts are conse co diagnase conditions oF to predict human oucomes. Opsimal plaaning and care ofien hinge on. che constants judgmental acairacy. Whether at physicians, psychia tests, oF psychologists, consultants perform swo basic Functions is decision-making; they colece and interpret data, Our interest hers inthe imerprexve function, specifically che relative merits of clinical versus actuarial methods AA, vcttamaie nari prsetaes auntouous sex7ToMs ‘Methods of Judgment and Means of Comparison to the clinial method the decision-maker combines or processes information in his o her head. Inthe actual or atic method the herman judge is eiminacd and conclusions ze soley on “mpi ctablshedeeiions benseen data and the condition oF ‘event of interest. A life insurance agente uses the clinical mechod if dita on ise factors ae combined through personal judgment. The agen uses the acurial method if ata are entered into formu, oF fabs and charts thar contain empincal inforteation relating these background data co life expectancy. ‘Chnical judgment should not be equated wich a clinica! seting or BML Dawes ead ole Depron of Soca ned Decatn Sac nd peer kplan, Carege Mela Unmeraty, Prob Pa S215 D Faux nectar ‘roschlay, Rhos ar orga Peaceney REOI90S, at ence peso, Begusmee af aychauy. and Hur Betas, Srowe rary Pope Bibione 7 £ Medd a Rope! Rotewor ef Petal snd poeta pousry {nd papi of renee, Cry a Moat Meapais, MN 6508S 1668 2 clinical practioner, A clinician i psychiatry o¢ medicine may use the clnieal or atuaeal method. Conversely, the servatial method should noe be equated with auromaced decision rules slone, For cxample, computers can automate clinical judgments. The computer can be programmed ro yield the description “dependency crits,” justas the cliucl judge would, whenever a certin response appears Ona psychotogical est. Tobe erly accutial,icerpettions must be both automatic (hac is, prespecied or coucinized) and based on empirically exeblshed relations Vireully ay type of data is aceoable co acwatial interpretation or example, interview ebservations ean be coded quanseatively {gasene appears withdrawn: (2 yes (2} no}. [cis thereby possible £ incorporate qualitative observations and quanetacive da inta te predictive mix. Actuarial outpuc satemen’s, or eoacusions, can adéress vieewally any eye of agnosis, description, or predic of thuman incerest “The combination of clinical and aeaaral methods ofes a tied potential udgment szazegy, ane for which certain viable apcoaches iave been proposed. However, most propos fr einicabaexuacial combinatidn presume thatthe avo jadgrnent methods work rogeth- er harmoniotsly and averlook the many sicuatons that require dichotomous choices, for example, whethee or not fuse an areipsychotic medication, grant pacae, or hosptaliz. elinical and accusalinexpretations agree dete is no need vo combine chee. If they dicagree, one must choose one or the other. If clinical ‘accepeeution suggests brain damage but the sccuaral method indicates otherwise, one does not conclade sac the patients and is soc brain damaged Although some research appeared on clinical and acruarial ju iment before the mid/fiftes, Mech! (1) introduced the issue to 2 broad range of social scientists in 1954 and stimulated a Furry of suis. Mech specified conditions fo a fair corapaison ofthe co methods. First, both methods should base judgments on the sire daa “This condition dees noe require that clinical judge and stastal method, before comparuon, use che sume data to derive decision sertegis of cules. The elinician’s development of interpetve ‘eratepies depends on prior experience and knowledge. The cevelop ene of seuarial methods reqites cases with known outcome. The dlnial and actuarial sategis may chus be derived fom separte or overlapping databases, al one or the othee may be based on more or fewer ees oF moe ar less outcome information. For example, the dinician may have iuexpreted 1000 inceligence cst for indica tions of brain dyfttion and may knaw the outcome for some of thse cases based on radiologic examination. The actuarial method may have been developed on the subset of these 1000 cases for ithich oatcome is known. Second, one must avoid conditions that ca aril inflate the accuricy of actuirial metnods. For example, che mathematical procedures (such 28 tegeession analysis or dscrimicare analysis) sed to develop static acuanal decision ales may capitalize on chance (nonrepesdag) relations among, variables. Thus, derivation SCIENCE, VoL. 243 typically should be followed by cross-validation, thar is, pplication ‘of the decision rule to new or fresh cases, or by a standard statistical ‘estimate of the probable outcome of cross-validation. Crass-validae tion counters artificial inflation in aceuracy rates and allows one 10

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