Human Error in Medicine

By Marilyn Sue Bogner | Go to book overview

7
Using Statistics in Clinical Practice: A Gap Between Training and Application

Roberta L. Klatzky Carnegie Mellon University

James Geiwitz Advanced Scientific Concepts

Susan C. Fischer Anacapa Sciences, Inc.

A woman who had undergone a mastectomy for breast cancer was concerned about being at increased risk for an independent occurrence of cancer in the remaining breast. She asked her doctor what the chances were of such an occurrence, and he responded, "about 1 in 12." "Isn't that better than normal?" she asked in surprise, to which he replied, "Well, the chance of having cancer in both breasts is well below that of having cancer in one."

The doctor is confusing a priori (beforehand, without knowledge of a previous cancer) and a posteriori (afterwards, knowing that cancer has occurred in one breast) probabilities of having cancer in two breasts. This confusion is hardly unexpected. Medical training does not make a person immune to the kinds of statistical reasoning fallacies that have been widely documented in other populations. Indeed, medical school does not provide a substantial background in statistics. Yet, statistical knowledge is increasingly in demand by patients and medical practitioners, and without such knowledge, errors can occur. This chapter describes a gap between the need for statistical knowledge and the degree of expertise characteristic of physicians in medical practice. It uses, as evidence for this gap, results of a study called the MD-STAT project. Finally, the chapter offers suggestions for reducing the gap between statistical knowledge and its need in medical practice.


WHAT IS STATISTICAL KNOWLEDGE?

The term statistical knowledge can be used in several senses. It can refer to knowledge of data regarding a particular disease -- for example, the magnitude of risk factors and the nature of survival given various courses of

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