Influences on Clinical Decision Making

Drug prescription statistics across Europe show that there are vast differences in drug usage in dermatology from country to country. The diseases and the science of medicine are the same, but prescribing practice is hugely influenced by local custom and experience, habit and prejudices. There must be something wrong.

Clinical decision taking is very complex and a huge range of issues influence the clinician (Figure 1). But the foundation of high quality decision taking should be evidence based scientific information about the disease and its possible treatment.

Much of the management advice given in this book is not evidence based. Some may later be shown to be incorrect. Although the authors have tried to give evidence based information, this book gives their current opinions and some of their biases. So how could this be improved? How can clinical practice become based more on evidence and less on opinion?