Personal view: victim blaming as management strategy for the gastroenterologist--a game theoretical approach

Blame others but hurt yourself: blaming or sympathetic attitudes toward victims of COVID-19 and how it alters one's health status

OBJECTIVE

This study explored the relationship between blame/sympathy and blamer's/sympathizer's perceived health status.

DESIGN

We recruited participants via an online survey platform. Study 1 was a cross-sectional study using data (N = 3304, Mage = 28.22, SDage = 7.92, and 39.3% female) collected from 30 provinces, municipalities, and autonomous regions of China on February 3, 2020. Study 2 used the daily diary method collecting data from February 4 to 9, 2020. Sample (N = 2456, Mage = 28.49, SDage = 7.49, and 39.4% were female) was obtained by inviting participants in Study 1 on the same platform.

MAIN OUTCOME MEASURES

Self-reported health status and life satisfaction.

RESULTS

In Study 1, blame was negatively associated with perceived health status, while sympathy was positively associated with it. Negative emotions and risk perception are the underlying mechanisms, but neither of them has effects on the relationship between sympathy and perceived health status. Study 2 replicated these results using multilevel analysis.

CONCLUSION

The results highlight the importance of people's attitudes on perceived health status. While sympathy is positively related to perceived health status, blaming has a negative association with perceived health status. Negative emotions and risk perceptions are the underlying mechanisms.

Cry wolf and inflate medical urgency to expedite consult resolution through gastrointestinal endoscopy

BACKGROUND AND AIMS

To expedite a consult resolution, referring physicians sometimes inflate the urgency and need for endoscopic workup. The aim of the present decision analysis was to study the impact of inflationary indication on the expected benefits to gastroenterologists and referring physicians.

METHODS

The study aims were pursued in terms of game theory and medical decision analysis using decision trees. Different outcomes associated with true versus false urgent indication in immediate versus delayed endoscopy were ranked according to different preference schemes of gastroenterologists versus referring physicians.

RESULTS

The decision analysis shows that inflating the urgency of indication for endoscopy reduces the benefit from the perspective of gastroenterologists and referring physicians alike. Raising the level of false urgent indications results in a lost opportunity for immediate endoscopy among patients with true urgent indications and, thus, diminishes the overall benefit of endoscopy. By comparison, all other influences play only a marginal role. For referring physicians, the small benefit of expediting nonurgent endoscopies by exaggerated claims does not compensate for the concomitant loss of truly needed endoscopy slots. For gastroenterologists, a small benefit derived from delaying endoscopies in patients with false urgent endoscopies rapidly wears off as inflationary indications become common practice.

CONCLUSION

An underlying communication problem between referring physicians and gastroenterologists needs to be resolved by educating referring physicians about the operative exigencies of endoscopy units and about the true appearance of alarm symptoms in common digestive diseases.

Challenges to the provision of diabetes care in first nations communities: results from a national survey of healthcare providers in Canada

Background

Aboriginal peoples globally, and First Nations peoples in Canada particularly, suffer from high rates of type 2 diabetes and related complications compared with the general population. Research into the unique barriers faced by healthcare providers working in on-reserve First Nations communities is essential for developing effective quality improvement strategies.

Methods

In Phase I of this two-phased study, semi-structured interviews and focus groups were held with 24 healthcare providers in the Sioux Lookout Zone in north-western Ontario. A follow-up survey was conducted in Phase II as part of a larger project, the Canadian First Nations Diabetes Clinical Management and Epidemiologic (CIRCLE) study. The survey was completed with 244 healthcare providers in 19 First Nations communities in 7 Canadian provinces, representing three isolation levels (isolated, semi-isolated, non-isolated). Interviews, focus groups and survey questions all related to barriers to providing optimal diabetes care in First Nations communities.

Results

the key factors emerging from interviews and focus group discussions were at the patient, provider, and systemic level. Survey results indicated that, across three isolation levels, healthcare providers' perceived patient factors as having the largest impact on diabetes care. However, physicians and nurses were more likely to rank patient factors as having a large impact on care than community health representatives (CHRs) and physicians were significantly less likely to rank patient-provider communication as having a large impact than CHRs.

Conclusions

Addressing patient factors was considered the highest impact strategy for improving diabetes care. While this may reflect "patient blaming," it also suggests that self-management strategies may be well-suited for this context. Program planning should focus on training programs for CHRs, who provide a unique link between patients and clinical services. Research incorporating patient perspectives is needed to complete this picture and inform quality improvement initiatives.

Personal view: the paradox of runaway competitions in gastroenterology

Occasionally, gastroenterologists harbour reservations about the appropriateness of various procedures and management options, yet find themselves drawn into a competition and forced by outside exigencies to provide such services. The aim of the present analysis was to describe patterns of runaway competitions and factors that influence their occurrence in gastroenterology. The interactions between two physicians or physician and patient are modelled as non-zero-sum games of two players. The outcomes associated with two behavioural strategies of two players are arranged in a two-by-two game matrix. Many scenarios of clinical gastroenterology and social interactions among gastroenterologists are characterized by the underlying game of prisoner's dilemma, where two players can choose to co-operate or compete with each other. Although from their joint perspective co-operation results in a higher joint utility, the perspective of each individual favours competition. Following the inescapable logic of their individual perspective, the players end up with a worse outcome than through co-operation. A runaway competition ensues if the game is played repeatedly with players successively increasing their stakes. Ultimately, each player tries to outdo the opponent while heading in the wrong direction. Recognizing the hallmarks of the game of prisoner's dilemma may help gastroenterologists to avoid such competitions.

Personal view: passing the buck and taking a free ride -- a game-theoretical approach to evasive management strategies in gastroenterology

BACKGROUND

'Free-riding' physicians enjoy the status, prestige and income of their profession without fully contributing to its overall mission. By shifting the costs of potential medical complications and difficult patient encounters to other physicians, they reap the benefits of their profession without carrying its full weight.

AIM

To describe this phenomenon in terms of decision analysis and characterize the parameters affecting its occurrence.

METHODS

The interaction between two physicians is modeled as a non-zero-sum game. Two strategies of either contributing to patient management or taking a free ride are available to both physicians. The four possible outcomes are arranged in a two-by-two game matrix.

RESULTS

Physicians practice medicine because their personal benefit exceeds their cost. High cost to the physician results in a high probability of taking a free ride and copping out from potentially risky management. Increasing the benefit decreases the probability of free riding. As the number of possible encounters with other physicians increases, the probability of free riding increases and the probability for effective management by each individual physician decreases.

CONCLUSION

If individual gastroenterologists felt less threatened by administrative repercussions and medico-legal consequences of untoward events, each one of them would contribute more to effective patient management.