'A Look at the Chief Complaints' revisited. Current obstacles and opportunities for decision analysis.

In 1979, Dr. William Schwartz wrote a "Sounding Board" article in the New England Journal of Medicine entitled: "Decision Analysis. A Look at the Chief Complaints". In it, he listed the major concerns of practicing physicians, academicians, and students about decision analysis. As an educator and an advocate of the technique, he then replied to each of these concerns and objections. Dr. Schwartz's article is an excellent and thoughtful discussion and one that we routinely recommend to our students to prepare them for real-world reactions to the zeal with which they often leave our classrooms. Now, more than four years later, I would like briefly to review the "chief complaints" outlined by Dr. Schwartz and to update them to 1984. My purpose is to consider the cognitive and practical obstacles to the dissemination of decision analysis, and to discuss alternative approaches to surmounting these obstacles. To do this, I have engaged four "consultants" from different fields.