Physicians likelier to test for conditions already seen in recent patients

Emergency department physicians who saw patients with a pulmonary embolism—a blood clot in the lung—were about 15% likelier over the next 10 days to test subsequent patients for the same thing.

Rules of thumb, also known as heuristics, could influence how physicians deliver care. One such rule of thumb is the "availability heuristic," under which a person assesses an event's likelihood by how easily the event comes to mind. For physicians, recent conditions seen may be particularly notable. Under this heuristic, if a physician sees a condition in a recent patient, they may be more likely to test for the condition in the next patient they see.

Dr. Dan Ly, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, examined 2011 to 2018 data from 7,400 emergency department physicians who cared for 417,000 patients with shortness of breath at 104 Veterans Affairs hospitals. He examined how often a physician tested for pulmonary embolism immediately after seeing the same diagnosis in a previous patient.

The findings provide large-scale evidence that the availability heuristic plays a role in how physicians make complex testing decisions. For patients, how physicians make care decisions may be influenced by things such as what that physician saw in the patient they had just cared for. For physicians, awareness of such heuristics may help lessen their influence.

The study is published in the peer-reviewed journal Annals of Emergency Medicine.