Clinical Judgment Gets Lift from Research

Article excerpt

Psychiatrists and other mental health clinicians demonstrate considerable flaws in the judgments they make about their clients, according to studies published over the past several decades. Statistical formulas employing background information better predict a client's prognosis or propensity to behave violently than do clinicians, and the professionals' years of experience fail to improve their insight into clients, these data indicate.

Think again, says a team of psychologists at Ball State University in Muncie, Ind. Preliminary results of their compilation and analysis of many clinical-judgment studies indicate that statistical models perform no better than flesh-and-blood clinicians on judgments common within the mental health field. Moreover, clinicians indeed become more accurate decision makers for many tasks as they accumulate experience, the researchers argue.

Previous dour assessments of clinical judgment have often rested on selective reviews of investigations that frequently contain methodological problems, contends project director Paul M. Spengler. Nonetheless, convictions about inherently inept clinical decisions have flourished, he says.

"Unevaluated assumptions are repeated like a mantra and achieve the level of myth, perpetuated by the very scholars who wish to reduce bias in clinical judgment," Spengler says.

He and his colleagues presented initial results of their metanalysis of clinical judgment research at the annual meeting of the American Psychological Association last week in San Francisco.

The Ball State group spent nearly 6 years tracking down 1,048 empirical studies of clinical decision making. These range from published articles to unpublished dissertations by psychology graduate students.

In one investigation derived from this research sample, Stefania Aegisdottir and Alan Maugherman chose 74 articles comparing statistical and clinical prediction in the mental health field. They have summarized the findings of 30 of those studies so far.

Experiments described in these articles focused on a number of assessments regarding individual clients, such as ascertaining the presence of brain damage, identifying personality traits, estimating future emotional adjustment or criminal behavior, and judging school performance. …