Decision support consists in helping a decision-maker to improve his/her decisions. However, clients requesting decision support are often themselves experts and are often taken by third parties and/or the general public to be responsible for the decisions they make. This predicament raises complex challenges for decision analysts, who have to avoid infringing upon the expertise and responsibility of the decision-maker. The case of diagnosis decision support in healthcare contexts is particularly illustrative. To support clinicians in their work and minimize the risk of medical error, various decision support systems have been developed, as part of information systems that are now ubiquitous in healthcare contexts. To develop, in collaboration with the hospitals of Lyon, a diagnostic decision support system for day-to-day customary consultations, we propose in this paper a critical analysis of current approaches to diagnostic decision support, which mainly consist in providing them with guidelines or even full-fledged diagnosis recommendations. We highlight that the use of such decision support systems by physicians raises responsibility issues, but also that it is at odds with the needs and constraints of customary consultations. We argue that the historical choice to favor guidelines or recommendations to physicians implies a very specific vision of what it means to support physicians, and we argue that the flaws of this vision partially explain why current diagnostic decision support systems are not accepted by physicians in their application to customary situations. Based on this analysis, we propose that decision support to physicians for customary cases should be deployed in an “adjustive” approach, which consists in providing physicians with the data on patients they need, when they need them, during consultations. The rationale articulated in this article has a more general bearing than clinical decision support and bears lessons for decision support activities in other contexts where decision-makers are competent and responsible experts.

决策支持包括帮助决策者改善其决策。但是，请求决策支持的客户通常本身就是专家，并且经常被第三方和/或公众带走以对他们做出的决策负责。这种困境给决策分析师带来了复杂的挑战，他们必须避免侵犯决策者的专业知识和责任。在医疗保健环境中诊断决策支持的情况尤其具有说明性。为了支持临床医生的工作并最大程度地减少医疗错误的风险，已经开发了各种决策支持系统，并将其作为信息系统的一部分，该信息系统现在在医疗保健环境中已经很普遍。与里昂的医院合作，开发用于日常习惯性咨询的诊断决策支持系统，我们在本文中建议对当前的诊断决策支持方法进行批判性分析，主要包括为他们提供指南甚至是成熟的诊断建议。我们强调指出，医师使用此类决策支持系统会引起责任问题，但也与习惯性咨询的需求和限制相矛盾。我们认为，向医生推荐指南或建议的历史选择暗示着对医生支持的意义的非常具体的看法，并且我们认为，这种看法的缺陷部分地解释了为什么当前的诊断决策支持系统不被医生接受。适用于习惯情况。根据此分析，我们建议应采用“可调整的”方式为医师提供针对常规病例的决策支持，其中包括在咨询过程中为医师提供他们所需要的患者数据。本文阐述的基本原理比临床决策支持更具通用性，并且在决策者有能力和负责任的专家的其他情况下，为决策支持活动提供了经验教训。