Clinical decision making is not always rational. Both clinicians and patients alike can sometimes make “irrational” treatment choices based on reward, risks, time, and potential trade-offs associated with therapy, as reported in an article published in the New England Journal of Medicine.

There is a sweeping assumption that clinicians are able to make decisions on alternative treatments based on a comprehensive set of data regarding the clinical and economic worth of these approaches. Unfortunately, comparative data often do not exist or are inadequate, which can result in less-than-ideal clinical decision making throughout the treatment process. Rather than relying on an “integrated overview of all the data,” many clinicians may make their treatment decisions on the basis of pharmaceutical promotional materials.

Academic detailing is an approach to help minimize “irrational” clinical decision making and involves educational outreach professionals who meet with physicians to discuss specific medication use scenarios. These educators use physicians’ biases and knowledge gaps to improve evidence-based prescribing practices. In addition, it has been suggested that the elimination of copayment requirements may improve patients’ clinical decision making in terms of adherence to medication. This increased adherence may subsequently improve outcomes and reduce total healthcare expenditures.

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There exists a need to develop strategies that influence clinical decisions that are driven by economic factors. For example, payment incentives can result in dialysis centers overusing or underusing erythropoiesis-stimulating agents, and the increased revenue associated with gray-zone chemotherapy treatments may increase the therapies’ use in oncology centers.

The study of “behavioral economics and the psychology of decision making can help us improve the outcomes of medical care and contain its costs,” the authors noted, as well as shift medical care to a primarily evidence-based approach.


Avorn J. The psychology of clinical decision making — implications for medication use. N Engl J Med. 2018;378(8):689-691.