Decision-Making under Uncertain Conditions: The Internist, as a Director of the Diagnostic/Therapeutic Pathway in Grey Zones

The internists should utilize both their clinic experience and medical literature's evidences, mediating with organizational context, patients' opinion and ethics. However, none of these components may be sufficient. In several medical sectors, we may find many and extensive grey zones in which a diagnostic intervention's effectiveness and/or its alternatives are uncertain. This cannot lead to the decision-making process's paralysis, because the evidence-based medicine requires to base any clinical decision on “the best available evidences” and not on “the best possible evidences.” Clinicians should be able to extrapolate the prevailing question structuring from patients' problem (PICO: problem, intervention, confront, outcome); identify the best available evidence and synthesize it; perform critical evaluation and information transfer (critical appraisal); in clinical efficiency, evaluate any action options.