Clinical versus Actuarial Judgment

Both clinical and actuarial judgments are key for professions all over the world. Depending on the judgment it is key in some fields more than others. The medical profession is one that depends solely on clinical judgments (Redelmeier, Ferris, Tu, Hux, & Schull, 2001). This is a judgment that is utilized in protecting and restoring human well-being. Clinical judgment is developed through knowledge, experience and practice and it makes up a doctor’s knowledge base on which they are able to make decisions (Kienle & Kiene, 2011). All information is processed in their head as opposed to doing research. Actuarial judgment tends to be more objective. Dawes, Faust, and Meehl described it as having the human judge eliminated and any conclusions made is due to how the data and the condition are related (Dawes, Faust, & Meehl, 1989).

A couple of years ago, I needed to make a clinical judgment due to health. I understood that there was something wrong with me, but I didn’t know what. There were no signs at the beginning and before things got worse, I had already scheduled an appointment to see my doctor. I knew that my heart rate should not be so high and that I should not have a shortness of breath after going up a flight of stairs. Outside of that, I felt fine. However, I knew of others who have had similar issues and I have read about these types of things in medical journals and on websites as to possible causes. My cardiologist also made a clinical judgment to have me admitted to the hospital right away. I had a pulmonary embolism. He did not have the data in front of him to prove it, but he was sure based off of his experience that he was right. This would usually be a task for a pulmonary doctor. An actuarial judgment may have been able to help me if I had all of the data I needed in order to figure out what was going on. I only had bits and pieces. Even my primary care physician could not figure it out. It was more of a hunch.

Recently, I needed to make an actuarial judgment when purchasing a truck. I couldn’t make a decision based off of what brand I liked or what looked good. I didn’t have experience with buying a truck before. I need numbers. I needed to know the towing capacity and the payload before I could buy one. Part of the reason is because I wanted to be able to tow an Airstream. If the truck is too small or the tow rating isn’t high enough, the truck would not be able to tow the load. Or worse, the load would weigh down the truck and ruin the suspension. Had I had the experience, I could have made a clinical judgment because I would have known the details of what I would have needed to pick. I would have known that the vehicle numbers are an indication as to how much a truck may be able to tow.

I prefer clinical judgments when necessary. If I’m out in the woods and I’m lost, there is no way I would be able to make actuarial judgments on what to eat, what to drink, or which way to go. I need to be able to make decisions based on my experiences as an outdoorsman. Sometimes, as a psychologist, being able to make clinical judgments may mean the different between life and death with regards to a patient who seems suicidal (American Journal of Psychiatry, 2003). I like clinical judgments to gut instincts. After you have experienced something, you can ride off of the experience. It may not always be perfect, but they help; especially in the case of the doctor who saved my life.

References

American Journal of Psychiatry. (2003). Practice guideline for the assessment and treatment of patients with suicidal behaviors. American Journal of Psychiatry , 160 (11), 1-60.
Dawes, R., Faust, D., & Meehl, P. (1989). Clinical Versus Actuarial Judgment. Science , 243 (4899), 1668-1674. ↩
Kienle, G. S., & Kiene, H. (2011). Clinical judgement and the medical profession. Journal of Evaluation in Clinical Practice , 17 (4), 621–627. ↩
Redelmeier, D. A., Ferris, L. E., Tu, J. V., Hux, J. E., & Schull, M. J. (2001). Problems for clinical judgement: introducing cognitive psychology as one more basic science. Canadian Medical Association Journal , 164 (3), 358-360. ↩