Understanding Doctor Decision Making: The Case of Depression Treatment

Abstract

Treatment for depression is complex, requiring decisions that may involve trade‐offs between exploiting treatments with the highest expected value and experimenting with treatments with higher possible payoffs. Using patient claims data, we show that among skilled doctors, using a broader portfolio of drugs predicts better patient outcomes, except in cases where doctors' decisions violate loose professional guidelines. We introduce a behavioral model of decision making guided by our empirical observations. The model's novel feature is that the trade‐off between exploitation and experimentation depends on the doctor's diagnostic skill. The model predicts that higher diagnostic skill leads to greater diversity in drug choice and better matching of drugs to patients even among doctors with the same initial beliefs regarding drug effectiveness. Consistent with the finding that guideline violations predict poorer patient outcomes, simulations of the model suggest that increasing the number of possible drug choices can lower performance.

Consequences of serious parental health events on child mental health and educational outcomes

“…GPs can have different approaches to treat children who experience a parent's health event. The limited evidence on doctors' practice styles suggest that doctors' practice style can be affected by the doctor's medical school rank (Schnell & Currie, 2018), their skill level (J. M. Currie & MacLeod, 2020), the doctor's personal beliefs about the benefits of a treatment and institutional settings (Cutler et al, 2019).…”

A Taste of Their Own Medicine: Guideline Adherence and Access to Expertise

“…It is possible that the care of more informed patients is guided by clinically relevant knowledge that is not used in the care of less informed patients, and that the more informed may benefit from their greater departures from guidelines. However, consistent with recent evidence that practitioners' departures from prescribing guidelines lead to worse patient outcomes (Abaluck et al 2020;Cuddy and Currie 2020;Currie and MacLeod 2020), it is also possible that more informed patients are overconfident or otherwise mistaken in deviating from guidelines. 3 We return to this issue in the conclusion.…”

“…healthier overall (Chen et al 2019). However, there is also evidence that practitioners' departures from prescribing guidelines lead to worse patient outcomes (Abaluck et al 2020;Cuddy and Currie 2020;Currie and MacLeod 2020). An important avenue for further research is to identify whether and when non-adherence is in the patient's best interest.…”

Treatment of mental illness in American adolescents varies widely within and across areas

“…Provider knowledge and preferences for different treatments may be important. It is possible to use claims data to find doctors who are “outliers” in terms of their practice styles in many settings ( 21 – 23 ). Previous work has shown that many psychiatrists have “favorite drugs” for most conditions, and that there are cohort-effects in physician practice styles ( 24 , 25 ).…”