Forced reflection led doctors to order fewer unnecessary medical services for their patients—leading to a host of benefits and no diminishment in care.
Overtreatment in American healthcare is a $200-billion-a-year problem—and a big part of that cost comes from doctors ordering unnecessary tests and services for their patients. It’s not just about money: these extra tests can add enormous stress to a patient’s life.
But recent research conducted by Boston University faculty members Jillian Berry Jaeker and Anita Tucker suggests that requiring doctors to spend a few moments justifying their decisions to order extra tests could reduce testing with no measurable impact on the quality of care. “From an operations perspective, we want to find ways to make things run as smoothly as possible. That often means removing obstacles like providing justification,” says Berry Jaeker. “But we found, counterintuitively, that there is a benefit to some kinds of friction in these processes.”
To study the problem, Jaeker and Tucker looked at the tests that doctors requested for patients experiencing abdominal pain in two nearby emergency departments. One department required doctors to justify their decision to a radiologist to get approval for an ultrasound scan, the other did not.
On average, physicians not required to justify their decisions ordered more than twice as many services for their patients than those who were required to do so. Yet those extra tests appeared to yield few benefits: patients who received extra tests were no less likely than their non-tested counterparts to revisit the emergency department within a week. Even worse, these extra tests had a domino effect, increasing other testing and waiting time for all patients by an average of seven minutes.
Berry Jaeker suspects that making a test too easy for doctors to order may lead them to request them less thoughtfully—without seeing the individual and system-wide implications of their decisions. When forced to reflect for a few moments, doctors may realize that certain tests are unlikely to make a difference.
While Berry Jaeker acknowledges that requiring doctors and radiologists to talk before every service ordered may not always be feasible, the larger takeaway—requiring justification for commonly overused services—is worth consideration for all medical facilities. “Doctors could be required to write their justification in a box on a chart, or even dictate it into a phone system,” she says. “Requiring a justification doesn’t have to feel extremely burdensome, but if it is a small burden, it could actually improve the whole system.”
Read the working research paper on SSRN.