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Getting Physicians to Change

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Getting Physicians to Change

Getting Physicians to Change Participants at the High Value Practice Academic Alliance (HVPAA) conference hosted by Johns Hopkins University School of Medicine.
Christina DuVernay and Michael Keating

Date: 11/20/2017

As many as 50 percent of antibiotic prescriptions in U.S. hospitals are unnecessary or inappropriate, according to studies cited by the Centers for Disease Control and Prevention. Such overuse exposes patients to potentially dangerous side effects, wastes resources and increases antibiotic resistance — a serious public health threat that accounts for almost 30,000 deaths annually, according to research published in the New England Journal of Medicine.

When strong evidence suggests adopting new practices, why don’t providers do so?

Action bias is partly to blame, says Douglas Hough, associate scientist at the Johns Hopkins University Bloomberg School of Public Health and author of Irrationality in Health Care: What Behavioral Economics Reveals About What We Do and Why (Stanford University Press, 2013). Being told to go home and get rest just isn’t satisfactory — patients want their provider to do something. Doctors, wanting to make patients feel heard and helped, sometimes go ahead and give patients what they want.

Another type of cognitive bias, hyperbolic discounting, also comes into play, says Hough. This is when immediate benefits (satisfied patients) are overvalued and longer-term effects (potentially deadly antibiotic resistance) are undervalued in decision-making.

Hough described these and other cognitive traps in a presentation entitled “Incentives and Physician Behavior Modification” at the inaugural national research and education conference of the HVPAA, which took place Oct. 8-9 in Baltimore. Sponsored by Johns Hopkins University School of Medicine and attended by nearly 200 clinicians, house staff and administrators from some 70 medical centers, the conference focused on improving value in health care by reducing unnecessary and wasteful practices.

Why Change Is So Hard

A physician who’s made a diagnosis of a particular disease and then always prescribes a specific treatment, and sees it work with his patients, says Hough, is going to be hard to persuade. “The most salient evidence is what doctors see with their own patients, in their own work. But they may see a biased sample, they may not actually see final results of their treatments, or there may be other treatments that are better but because they don’t use those treatments, they don’t see results with their own eyes,” he says.

Financial incentives do little good over the long term to change behavior, but applying the principle of least effort can be effective in encouraging higher-value choices. “Make it easier for physicians and patients to choose higher-value tests and treatments, harder to choose lower-value ones,” he says. In the electronic health records systems, for instance, set up defaults to higher-value options. “Practitioners can still choose lower-value tests and treatments, but they have to jump through more hoops to do so,” he explains.

Applying the principle of social norming is effective, too. When physicians perceive that  most of their peers are practicing in a new way, they are motivated to do the same themselves.

To learn more about the application of behavioral economics to health care, consult these resources: