First Do No Harm? Doctor Decision Making and Patient Outcomes

Doctors facing similar patients often make different treatment choices. These decisions can have important effects on patient health and health care spending. This paper seeks to organize the recent economics literature on physician decision making using a simple model that incorporates doctor diagnostic and procedural skills, differences in beliefs and patient populations, and incentives. Economic considerations that affect the quality of decision making include training, experience, peer effects, financial incentives and time constraints. We also consider interventions aimed at improving decision making including provision of informational, heuristics and guidelines, and the use of technologies including electronic medical records and algorithmic decision tools. Our review suggests that we have learned a great deal about specific factors that influence doctor decision making but that our knowledge of how to apply that knowledge to improve health care is still quite limited.