How using Behavioural Science helps reduce doctors over-testing

It’s no secret that excessive medicals tests and treatments can lead to extreme financial, emotional, and personal costs; and often they contribute rising healthcare costs, particularly in countries like the United States.  So why do doctors overtreat patients? Research from Behavioural Science suggests that the Hawthorne Effect might help to explain this.

A group of medical educators has hypothesized that the source of the problem lies in how doctors are trained.  There is a fundamental assumption that the more procedures a doctor performs, the more confident they will be when they are independent.  A 2014 study published in JAMA shows that doctors who trained in areas where patients were subjected to more tests, went on to practice medicine in the same aggressive style.  

Now there are efforts to challenge this style of education by focusing on the ‘human costs’ of treatment; in other words, more tests and more information are not always best for the patient.  With more tests performed, a doctor will inevitably find some sort of abnormality that could be meaningless; yet the doctor feels compelled to treat it, and it actually makes the patient feel less well!  

But there is a silver lining—a group of professors at John Hopkins Hospital in Baltimore is leveraging the competitive spirit of doctors to show them how they are comparing to their peers in terms of tests and treatments. Professors here are giving out personalised reports that show how individual doctors stack up against their peers.  While the results aren’t in yet, they hope these reports will be effective in reducing unnecessary medical tests.  

Essentially what these professors are doing is utilizing the Hawthorne Effect, the idea that an individual behaves differently when he or she feels as if they are being watched.   This type of peer pressure is not only useful to doctors in training but also can be helpful for fully trained doctors. 

Dr. Adam Cifu, a professor at the Pritzker School of Medicine in Chicago recalls being singled out for over-using broad-spectrum antibiotics for ordinary unrainy tract infections. Knowing how he compared to his colleagues caused him to reign in his prescribing habits.  There have been similar efforts in Australia; to learn more check out our other blog post on curbing the prescription of antibiotics.  

As marketers, we can leverage ‘this feeling of being watched’ to help drive best practice in the clinical world—whether it be reducing unnecessary tests or treatments or curbing the over-prescription of antibiotics.  For ordinary folks, it can be used to help drive sustainability efforts (reduce water usage, encourage recycling, and reduce waste) or to make healthier lifestyle choices (e.g. step challenges with friends).  There are many ways in which the Hawthorne Effect can be employed, and this article demonstrates that people do indeed bow to social pressures. 

Link to the original article: https://www.npr.org/sections/health-shots/2019/04/19/715113208/why-do-doctors-overtreat-for-many-its-what-they-re-trained-to-do