Clinical Judgment and Computers

Abstract

The increasingly frequent application of formal methods, including algorithms and computer programs, to processes that are ordinarily viewed as judgmental seems to be a source of both promise and unease for physicians. A consideration of some of these methods suggests that it may be helpful to attempt to distinguish carefully between judgment and computation. Medical care involves a complex of inferential processes, any of which may be performed as judgments, and some of which may be carried out as a computation. My purpose here is to identify the latter cases. The empirical evidence suggests that such a demarcation is feasible. The most important question appears not to be "Where can we use computers?" but "Where must we use human beings?" Until this matter is more thoroughly explored, tension between physicians and computer advocates will persist. (N Engl J Med. 1980; 303:192–7.)