Diagnosing Physician Error: A Machine Learning Approach to Low-Value Health Care
利用机器学习分析医生诊断心脏病时的测试决策，发现医生同时存在过度测试和测试不足两种错误，导致医疗资源浪费和患者不良健康后果，并指出这些错误源于认知偏差而非单纯激励问题。
Abstract We use machine learning as a tool to study decision making, focusing specifically on how physicians diagnose heart attack. An algorithmic model of a patient’s probability of heart attack allows us to identify cases where physicians' testing decisions deviate from predicted risk. We then use actual health outcomes to evaluate whether those deviations represent mistakes or physicians’ superior knowledge. This approach reveals two inefficiencies. Physicians overtest: predictably low-risk patients are tested, but do not benefit. At the same time, physicians undertest: predictably high-risk patients are left untested, and then go on to suffer adverse health events including death. A natural experiment using shift-to-shift testing variation confirms these findings. Simultaneous over- and undertesting cannot easily be explained by incentives alone, and instead point to systematic errors in judgment. We provide suggestive evidence on the psychology underlying these errors. First, physicians use too simple a model of risk. Second, they overweight factors that are salient or representative of heart attack, such as chest pain. We argue health care models must incorporate physician error, and illustrate how policies focused solely on incentive problems can produce large inefficiencies.