Rational choice, prediction and medical decisionmaking. Contribution of severity scoring systems.

The aim of this study was to determine what type of representation the medi cal doctor adopted concerning the uncertainty about the future in criticall y ill patients in the context of preoperative evaluation and intensive care medicine and to explore through the representation of the patient health s tatus the different possibilities of choice he was able to make. The role p layed by the severity classification systems in the process of medical deci sion-making under probabilistic uncertainty was assessed according to the t heories of rational behaviour. In this context, a medical rationality neede d to be discovered, going beyond the instrumental status of the objective a nd/or subjective constructions of rational choice theories and reaching a d imension where means and expected ends could be included. (C) 2001 Editions scientifiques et medicales Elsevier SAS.