title: Gambles of gastroenterology.
abstract: BACKGROUND
  Diagnostic and therapeutic procedures of gastroenterology can frequently tax a patient's health. In addition to the risk of side-effects such procedures may also reduce the patient's well-being. The probability of achieving cure depends on the interplay between the patient's initial health status and the expected efficacy of the gastroenterological interventions.
  
  
  METHODS
  The mathematical concept of the 'gambler's ruin' from probability theory is used to model the interplay among the various factors affecting clinical outcome.
  
  
  RESULTS
  The model illustrates in a quantitative manner how the physician's ultimate success in achieving cure depends on a given patient's initial health status, and the characteristics of the interventional procedures used. The analysis also illustrates that in some dire clinical situations, risking the patient's life in one single and bold step can yield a better overall outcome than trying to advance the patient's health by multiple small and cautious steps.
  
  
  CONCLUSIONS
  Using the gambler's ruin as a model for medical risk taking could contribute to medical teaching and promote the understanding of the some general principles that shape many clinical decisions in gastroenterology.
authors.affiliation: Portland VA Medical Center Oregon Health and Science University, Portland, Oregon 97239, USA. sonnenbe@ohsu.edu
authors.forename: Amnon
authors.initials: A
authors.lastname: Sonnenberg
mesh_terms: D000368:Aged; D003661:Decision Support Techniques; D003938:Diagnostic Techniques, Digestive System; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000628:therapy*; D006304:Health Status; D006801:Humans; D008297:Male; D011338:Probability Theory; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome