In particular, there is an emphasis on the clinical
utility of these instruments—the extent to which
these measures provide data that improves the deci-
sions made by clinicians as well as the outcomes
experienced by patients. Therefore, clinicians are
encouraged to used evidence-based assessments
with demonstrated utility to inform their own
judgments, as opposed to offering clinical judg-
ments based only on subjective factors (e.g., clinical
intuition, hunches, etc).
Objections to These Findings. Dawes (1994) has
outlined several of the major objections to the large
body of evidence supporting the superiority of statis-
tical prediction, along with responses to each objec-
tion. First, critics argue that several of the individual
studies reviewed contained research design flaws that
may have affected the findings. Dawes (1994) refers
to this as an“argument from a vacuum”because a
possibility is raised, but there is no empirical demon-
stration supporting the possibility. Although every
study has its limitations, it is difficult to imagine
that the opposite conclusion (clinical prediction is
superior) is warranted when practically all of the
studies support statistical prediction.
The second objection concerns the expertise of
the judges/clinicians in these studies. Perhaps they
were not “true”experts, and a study employing
expert clinicians would demonstrate the superiority
of clinical judgment. Although a wide variety of
judges/clinicians were used in these studies, a num-
ber employed recognized“experts”—clinicians with
many years of experience performing the predictive
task in question. There were a few instances in
which an individual clinician performed as well as
the statistical formula, but this was more the excep-
tion than the rule. Thus, there is no compelling
empirical evidence that expert clinicians are superior.
We will return to the issue of whether clinical
experience improves judgment accuracy later.
A third objection is that the predictive tasks were
not representative of prediction situations facing clini-
cians (i.e., not ecologically valid). A clinician’s diagnosis
may not be based only on the MMPI-2, for example,
but also on an interview with the patient. Dawes (1994)
argues, however, that the predictive tasks are compo-
nents of what may go on in clinical practice—clinicians
purportedly use the MMPI-2 information to make
predictions. Further, several of the studies demonstrate
that additional information(e.g., interview material)
obtainedandusedinthejudge’sclinicalprediction
may actually result in less accurate predictions than
would be the case if the clinician had simply“stuck
with”the statistical formula that was available.
Dawes (1994) goes on to suggest that much of
the negative reaction to the findings is a function of
our human need to believe in a high degree of
predictability in the world. This appears to be both
a cognitive and an emotional need. People have a
built-in tendency to both seek and see order in the
world, and a lack of predictability in the world is
likely to result in some degree of discomfort or emo-
tional distress. However, the need for predictability
does not prove its existence.Bias in Clinical Judgment. Clinical judgment
suffers when bias of any kind intrudes into the
decision-making process. Bias exists when accuracy
of clinical judgment or prediction varies as a func-
tion of some client or patient characteristic, not
simply when judgments differ according to client
characteristics (Garb, 1997, 1998). For example,
finding that a higher percentage of women than
men are judged to suffer from major depression
would not indicate a bias against women. However,
finding that a higher percentage of women than
men are given this diagnosis when the same symp-
toms are presented would indicate bias.
Garb (1997) reviewed the empirical evidence for
race bias, social class bias, and gender bias in clinical
judgment. Interestingly, he found that many conven-
tionally held beliefs about these types of bias were not
supported. For example, there was little support for
the beliefs that (a) lower-socioeconomic-class patients
are judged to be more seriously disturbed than those
from higher socioeconomic classes or (b) women
patients are judged to be more disturbed or dysfunc-
tional than men patients. However, there was strong
evidence to support the existence of several other
types of bias: (a) Black and Hispanic patients whoCLINICAL JUDGMENT 293