The Subliminal Psychology behind Ordering Tests

Medical tests have come under close scrutiny in this era of health care cost containment. Test over-ordering is thought to arise largely from the practice of defensive medicine, but Victoria Shaffer, assistant professor of health sciences at the University of Missouri School of Health Professions, has a different hypothesis and has been researching how doctors make test-ordering decisions. In a study published in Health Psychology Shaffer, human factors engineer Adam Probst, and pediatrician Raymond Chan, MD, examined the relationship between how tests are displayed in EMR systems and the number that are ordered.

The study looked at three different ways tests are displayed on electronic health records — one presented tests unchecked by default where the physician had to check the test to be done (opt-in format); one showed tests preselected which had to be unchecked (opt-out tests); and a third showed a few pre-selected tests.  The results of this study corroborated Shaffer’s hunch — more tests were ordered when doctors had to opt-out. She thinks the use of opt-in defaults would result in better care for patients and lower costs.

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