Clinicians are humans, too, and they are prone to social pressure just like the rest of us. Let’s explore a few interesting case examples of this to get a flavor of what might be at play here.
In 2016, some researchers published a paper looking at ways to reduce inappropriate antibiotic prescription by clinicians in primary care settings in Boston and Los Angeles. There were three groups in this randomized experiment. In the first condition, when clinicians prescribed an antibiotic, they were prompted to add a justification for why they were doing this in the electronic medical record (EMR) that would be visible to the patient and other healthcare professionals at the hospital. This condition was called “accountable justification.” In the second group, clinicians were sent an email every week about their performance. Clinicians who had low antibiotic prescribing habits were told they were “high performers” and were given a comparative viewpoint of how their level of prescribing compared to their peers. Clinicians who had high antibiotic prescribing habits were told they were “low performers” and were also given a comparative viewpoint of how their level of prescribing compared to their peers. In the third group, clinicians who prescribed antibiotics were prompted by the EMR to review alternatives like over-the-counter medications. In the end, the first and second interventions were both successful at actually reducing inappropriate antibiotic prescribing. The takeaway here is that clinicians are influenced by what their peers do.
There are a few other examples of ways in which clinicians are influenced by social pressure. There’s the famous Dartmouth Atlas of Healthcare [archived link], which shows areas of what’s called “small area variations” in healthcare. This means that from one place to the next, there can be wildly different approaches to the same health issues. For example, studies from the Atlas found [archived link] that in some places in Vermont, there was a very low number of tonsillectomies, but in neighboring parts of New Hampshire, with very similar demographics, there was a very high number of tonsillectomies. The underlying theory here is that physicians are influenced by what other physicians are doing, creating a norm in one area that might not be the norm in a very similar area nearby.
Clinicians can also experience social pressure from patients. This is often what’s behind overprescription of antibiotics. This kind of social pressure is very real.
The bottom line? Clinicians are human! We shouldn’t necessarily expect them not to be prone to social pressure, which is one of the most human phenomena there is. However, it should alert us to tactics that take advantage of this reality, such as the one in the first experiment described in this post. Let’s use this knowledge to our benefit.
Love,
Those Nerdy Girls
