Decision making in sports and in medicine: refereeing the game.

Physicians are constantly called on to make decisions regarding their patients in different contexts and with varying degrees of certainty. In medicine, decisional and diagnostic processes precede the application of (therapeutic) management “rules” and are effective only once the correct diagnosis has been formulated. In contrast, in sports, the application of existing rules is contemporaneous with the playing of the game and takes place in “real time”. Game rules contain features that may be considered, in a general way, as being “objective” and “subjective”. Rules in medicine, like sports, may be seen to possess subjective and objective features. Subjectivity in its broader sense is present in the components of technical ability, human sensibility, and relational competence in all the discernible steps in any clinical decision-making process. Objective elements, on the other hand, are represented by the evidence drawn from biostatistics and clinical epidemiology. It bears noting, finally, that a referee’s decision of an “offside” or a “false start” affects the life of a game. Physicians when caught offside or making a false start in their decision-making affect the game of life!