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Purpose: To determine if status quo and omission bias influence the medical decisions of pulmonary specialists.
Methods: We designed three case vignettes that presented patient information with an associated patient management choice. Two versions of each vignette differed in the status quo state relating to the management choice that must be made. Versions of vignettes 1 and 2 also differed in whether action was required on the part of the decision maker. The case vignettes were administered during the first mailing of an opinion survey sent to 500 practicing pulmonary specialists. Chi-square tests were used for all comparisons.
Results: There were 122 respondents to the first mailing of the survey. Vignette 1 presented a patient with a low probability of pulmonary embolism and respondents were asked to choose between discharge of the patient versus ongoing evaluation. The status quo state varied in the two versions of the vignette by whether ongoing evaluation had already been initiated. Respondents were significantly more likely to choose ongoing evaluation if it had already been ordered and action was required to stop it (71% vs. 53%; RR = 1.6, p = 0.048). Vignette 2 presented a patient in shock and respondents had to decide whether or not to place a central venous catheter in addition to vasopressor therapy. Respondents were significantly more likely to forego placement of the catheter if a vasopressor had already been initiated and omission was an option (71% vs. 50%; RR = 1.70, p=0.019). Vignette 3 presented a patient scenario and a hypothetical study which suggested that a routinely used but unproven therapy was shown to be harmful. In this vignette, the status quo varied between forms, but both forms required a choice between action and omission, and use of the therapy did not differ significantly based on whether it had already been initiated (50% vs. 55%; RR = 0.91, p = 0.60).
Conclusion: Medical decisions by pulmonary specialists vary according to normatively irrelevant status quo states, but this effect disappears after controlling for the action/omission distinction. Physicians should be aware that status quo and omission bias can influence medical decision making. Further study of the role of these biases in medical contexts is warranted.
See more of Poster Session - Clinical Strategies; Judgment and Decison Making
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)