Surgical decision making. The reproducibility of clinical judgement.

A considerable portion of negative surgical second opinions may represent nothing more than reasonable interobserver variation (reliability) among clinicians. In a previous study, four fictional cases were developed for each of seven different disease processes. The appropriate case histories were mailed to a random sample of board-certified surgeons. They were asked to render a decision on the need for elective operative intervention. This report presents a two-year follow-up, in which all surgeons who responded to the original questionnaire were asked to reevaluate the same vignettes. By comparing an individual surgeon's set of responses, the presence of intraobserver variation (reproducibility) was noted. The results of this follow-up showed that a surgeon's judgment with regard to the same hypothetical elective clinical situation seems to differ over time. If both the reproducibility and reliability of clinical surgical judgment are as variable as these studies indicate, then the theoretical premise on which second-opinion programs are based would seem to be in need of reexamination.