Hassle Your Doctor

Forcing doctors to justify tests could save big bucks

Overtreatment in American health care 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 by Questrom’s 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,” says Berry Jaeker, an assistant professor of operations & technology management. A lot of the time, that means cutting back on red tape. “But we found, counterintuitively, that there is a benefit to some kinds of friction in these processes.”

To study the problem, Berry Jaeker and Tucker, an associate professor of operations & technology management, looked at the tests that doctors requested for patients experiencing abdominal pain in two emergency departments. One department required doctors to justify their decisions 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 them were no less likely than their nontested counterparts to revisit the emergency department within a week. These extra tests also had a domino effect, increasing other testing and waiting time for all patients by an average of seven minutes.

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. “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.”