Clinical judgment v business judgment

Physician entrepreneurs have to reconcile the similarities and differences between the ethics and culture or business with the ethics and culture of medicine. What's more, the clinical mindset is different from the entrepreneurial one. However, both involve having the judgement to make the best decisions.

Clinical judgment is the?accumulation of knowledge ,skills, abilities, and competencies over time, which informs clinical decision making that complies with a standard of care. The medical educational system is an apprenticeship model that is designed to graduate trainees so they can practice independently and adhere to those standards.

As noted by author Kathryn Montgomery in her book. "How Doctors Think", medicine is neither a science nor a technical skill. Instead, it is an interpretive practice using practical reasoning i.e. judgment to determine the best course of action for each individual unique patient.

The Business Judgment Rule is a legal doctrine that helps to guard a corporation's board of directors (B of D) against frivolous legal allegations about the way it conducts business. A legal staple in?common law?countries, the rule states that boards are presumed to act in "good faith"—that is, within the?fiduciary?standards of loyalty, prudence, and care directors owe to stakeholders. Absent evidence that the board has blatantly violated some rule of conduct, the courts will not review or question its decisions.

Fiduciary standards include the "duty of care" and the "duty of loyalty." The first is an obligation to act on an informed basis. The second requires directors to put the interests of the corporation and over their own self-interest or the interests of others.

New technologies, like artificial intelligence, present ethical and social issues that require rules, regulations and rights to use them responsibly.

Bloom’s Taxonomy is a system of hierarchical models (arranged in a rank, with some elements at the bottom and some at the top) used to categorize learning objectives into varying levels of complexity.?

Judgment represents a higher level of cognition and decision making and is the foundation of creative problem solving, including devising new, useful, and non-obvious solutions.

New advances in large language models highlight the complexities of how humans think, process information, and make decisions and are forcing a re-examination of how we teach doctors to use decision making tools to improve outcomes and achieve the sextuple aims.

Amidst these volatile, uncertain, complex and ambiguous conditions, physician entrepreneurs will need to:

1. Improve how people learn
2. Apply behavioral economics to change behavior
3. Create guardrails to insure responsible use
4. Discover more about how our brains works
5. Manage the consequences of direct and indirect brain-machine interfaces
6. Create business models that work
7. Measure the systemic and clinical impact of shiny new objects like Web 3.0 and the metaverse and quantum computing
8. Overcome the barriers to data interoperability
9. Manage the unintended social and political ramifications of pervasive technology
10. Be wiser and avoid the Dunning-Kroger effect

Unfortunately, there are no CPT codes or reimbursement for clinical judgment. Its value is grossly undervalued and difficult to measure let alone duplicated by algorithms. In contrast, markets, shareholders, and customers rate your business judgment instantaneously and vote with their wallets.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs