Does Decision Support Make Docs Look Dumb?

Most clinicians would agree that evidence-based decision support tools have the potential to improve clinical quality. But patients’ perception of the tools—and the physicians who use them—might be yet another barrier to their adoption. The problem is twofold: Some patients are skeptical of docs who need a computer to help them make a diagnosis. And some physicians don’t want to be seen as being too reliant on technology.

In one study, waiting room patients were read various scenarios about physicians who used decision support and heeded the recommendation or ignored it in favor of a less aggressive or more aggressive treatment. Participants in the 2008 study, published in the journal Medical Decision Making, “always deemed the physician who used no decision aid to have the highest diagnostic ability” on a five-point scale, the researchers said.

James Wolf, an associate professor of information systems at Illinois State University’s School of Information Technology who studies physician adoption of—and resistance to—technology, saw similar results in his most recent studies. In one, even tech-savvy undergraduate and graduate computer science students preferred physicians who rely on intuition instead of computer aids.

“Patients object when they ask their doctor a question and then she or he immediately types in the question into their laptop and then reads back the answer. It gives patients the feeling that they just paid a $25 copay to have someone Google something for them,” Wolf says.

And that perception, in turn, worries doctors. “Physicians are reluctant to adopt computer-based diagnostic decision aids, in part due to the fear of losing the respect of patients and colleagues,” Wolf says.