Effects of Outcome on Physicians' Judgment of Appropriateness of Care

To the Editor.  —Caplan et al¹ showed an outcome bias in physician evaluations of patient care. In research on error, it is critical to distinguish outcome failures from deficiencies or defects in the decision-making or problem-solving process.Not all defects in decision processes are associated with bad outcomes; other factors may be necessary for the defect to propagate along a chain of negative consequences.² Conversely, bad outcomes can occur despite good decisions, ie, despite complete and thorough consideration of all of the available information, goals, and contributing factors.³ Appreciating this fundamental aspect of human decision behavior is critical for

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