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Counterfactual reasoning

Counterfactual Clinician Feedback is intended to address a common failure mode in clinical decision making: lack of explicit counterfactual reasoning about the current treatment plan.

In many workflows, clinicians can state what they are doing and why, yet cannot reliably answerthe counterfactual question: “What would we expect to happen if we did not do this, or if we did an alternative instead?” The absence of counterfactual structure drives three practical risks:

  1. Inertia risk: treatment plans persist because they exist, not because they dominate alternatives.
  2. Attribution error: changes in patient state are over-attributed to interventions, under-attributed to natural history or confounding.
  3. Calibration drift: the clinician receives weak feedback on whether their chosen plan was meaningfully better than plausible alternatives.

mike_tremblay@skythunder.net