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Influence diagrams have become a popular tool for representing and solving decision making problems under uncertainty (Shachter, Operations Research 1986;34:871–82). We show here some practical difficulties when using them to construct a medical decision support system. Specifically, it is hard to tackle issues related to the problem structuring, like the existence of constraints on the sequence of decisions, and the time evolution modeling; related to the knowledge-acquisition, like probability and utility assignment; and related to computational limitations, in memory storage and evaluation phases, as well as the explanation of results. We have recently developed a complex decision support system for neonatal jaundice management — a very common medical problem — , encountering all these difficulties. In this paper, we describe them and how they have been undertaken, providing insights into the …