The Paradox of Choice in Medicine

The greatest benefit of being a trainee in medicine is the ability to bear witness to how different physicians in the same specialty approach the same patient situation in different ways. It is not rare to find myself wondering how two people who are boarded by the same national specialty organization come to sometimes drastically different decisions on the tests they want ordered and even the decision to take a patient to surgery or not.

In many ways this observation stands as a testament to the complexity of medical practice in the modern world. With each passing day, the number of lab tests, imaging studies, and medical diagnoses expand at an exponential rate. And with it, the combination one could use to arrive at the final recommendation for the patient.

However, these endless options also come at a cost to the patient in the form of patient frustrations.

This is further underscored by the availability of immediate access to medical services via telehealth and same-day appointments where patients no longer wait to see the same primary or even specialty providers. This is more pronounced in managed care organizations where health care providers within the same specialty are often viewed as interchangeable entities, resulting in a patient seeing multiple providers to manage a particular presenting health concern, leading to multiple ways of uncovering the diagnoses.

I often see the impact of these shuffled outpatient health care interactions when I get called to evaluate patients in the emergency department.

Patients share narratives of distrust and dissatisfaction as a result of the multitudes of different plans made for them by the different providers. They are often frustrated that each provider orders a new test only to be sent to another provider for the interpretation of those results. Even with the use of electronic medical records, where one is able to access the clinical thought process of other providers, patients are starting to become burdened by the enormity of options at hand.

In many ways we are beginning to face the paradox of choice in medicine, both from a patient and provider perspective. As Barry Schwartz describes in his book “The Paradox of Choice: Why More is Less,” consumers are crippled by the concurrent abundance of choice, often leading to long term dissatisfaction.

Patients who consume health care are feeling similar emotions in today’s evolving health system. Additionally, providers who have the burden of choosing from a large armamentarium of tests and imaging modalities to arrive at diagnoses are facing the sting of dissatisfaction from spending more time choosing between options and less time interacting with patients. The solution to this paradox is not clear, but one that we as an industry need to think about deeply to sustain patient and provider satisfaction in the long run.

Dr. Jerome Chelliah is a resident physician in Obstetrics and Gynecology as well as a 2018–2019 Doximity Author.

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