General problems in medical decision making with comments on ROC analysis.

Medical decision-making studies continue to focus on two questions: How do physicians make decisions? How should physicians make decisions? Researchers pursuing the first question emphasize human cognitive processes and the programming of symbol systems to model observed human behavior. Those researchers concentrating on the second question assume that there is a standard of performance against which the physician's decisions can be judged, and to help the physician improve his performance, an array of tools is proposed. These tools include decision trees, Bayesian analysis, decision matrices, receiver operating characteristics (ROC) analysis, and cost-benefit considerations including utility measures. Medical decision-making questions must be answered in an ethical context where ethics and decision analysis are interviewed.