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Top medical doctors ‘undertest’ sufferers to display diagnostic prowess to friends, research finds

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Some skilled medical diagnosticians could restrict the variety of affected person assessments they order as a method to sign a excessive degree of competence to their friends, in response to a brand new research from researchers at Johns Hopkins University.

These “high-type” consultants interact in “undertesting” regardless of a rise in diagnostic strategies, together with artificial intelligence tools that may assess affected person situation extra precisely than previous strategies, say co-authors Tinglong Dai and Shubhranshu Singh, affiliate professors on the Johns Hopkins Carey Business School. While these consultants care about their sufferers’ welfare and would possibly really feel that assessments can burden sufferers with steep monetary, bodily, and emotional prices, the medical doctors are additionally involved about sustaining their reputations as top-flight diagnosticians, Dai and Singh notice.

Conclusions had been based mostly on a game-theoretic mannequin created by the researchers and supported by in-depth interviews with medical professionals.

“These doctors believe that they know what’s best and that testing isn’t always necessary. Testing has implications and may lead some of their peers to have less regard for their inherent diagnostic skills,” explains Dai.

Singh provides, “Past studies have shown an industry bias against doctors who perform numerous tests.”

“Low-type” consultants—those that are much less skilled and never as nicely skilled as high-type medical doctors—have a tendency to not undertest out of concern they could in any other case miss important data. They understand that the loss to sufferers’ welfare could be a lot bigger in the event that they engaged in undertesting by not ordering blood analyses, X-rays, ultrasound scans, and different assessments. These low-type consultants select to not sacrifice sufferers’ welfare for the reputational advantage of being perceived as high-type consultants.

The researchers’ findings are contained within the paper “Conspicuous by Its Absence: Diagnostic Expert Testing Under Uncertainty,” revealed in Marketing Science.

Most investigations of medical diagnostics have centered on excessive ranges of testing, notably within the context of economic incentives linked to testing. Dai and Singh’s paper departs from this line of inquiry by inspecting the motives behind low ranges of testing. As the authors write, “undertesting has emerged as an important source of misdiagnosis but has not received due attention from either the public or the health care community.”

Experts’ reluctance to carry out assessments turns into extra problematic within the face of the brand new diagnostic functionality enabled by artificial intelligence. These tools “are set to transform much of the health care sector [by] leveraging big data and deep learning to aid physicians in reaching more precise diagnosis,” the authors write.

Yet conditions nonetheless exist when extremely expert medical doctors are unable to sign their diagnostic skill by way of undertesting. These happen when the reputational payoff for ordering broader assessments is both very giant (for instance, in a specialty through which the physician closely depends upon peer referrals) or very small (as in a specialty through which the physician depends much less on peer referrals).

A attainable method to discourage undertesting by physicians could be to supply them monetary incentives, the authors recommend. They add, nonetheless, that prime medical doctors would doubtless see taking incentives as a poor reflection on their diagnostic abilities and thus would decline them.

Undertesting has no less than one constructive impact, Dai says.

“You could argue that it helps by making various doctors’ skill levels known among their peers,” he provides. “But given what’s at stake in health care, maybe we should worry more about patients and their outcomes rather than how doctors make their reputations known to one another.”

Financial incentives plus data lower affected person desire for diagnostic testing

More data:
Tinglong Dai et al. Conspicuous by Its Absence: Diagnostic Expert Testing Under Uncertainty, Marketing Science (2020). DOI: 10.1287/mksc.2019.1201

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Johns Hopkins University

Top medical doctors ‘undertest’ sufferers to display diagnostic prowess to friends, research finds (2020, January 31)
retrieved 21 May 2020

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