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

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.