Physician evaluation after medical errors: does having a computer decision aid help or hurt in hindsight?

Area of Science:

• Medical Informatics
• Human-Computer Interaction
• Medical Ethics

Background:

• Physicians increasingly use computerized decision aids (CDAs) in clinical practice.
• The impact of CDA use on patient perceptions of physician performance and liability is not fully understood.

Purpose of the Study:

• To investigate how physicians' use of CDAs influences patient satisfaction and blame for medical outcomes.
• To assess the effect of agreeing with, defying, or not using CDAs on perceived physician fault and competence.

Main Methods:

• Two experiments were conducted involving undergraduates and medical students.
• Participants evaluated scenarios where physicians used or did not use CDAs, with varying diagnostic accuracy and outcomes.
• Key metrics included ratings of doctor's decision quality, likelihood to recommend, negligence, fault, and competence.

Main Results:

• In positive outcomes, CDA use led to less positive ratings; in negative outcomes, less negative ratings.
• Agreeing with or heeding the CDA was linked to reduced physician fault compared to defying it or not using an aid.
• Medical students judged physicians less harshly than undergraduates but accurately predicted layperson responses.

Conclusions:

• Adhering to CDAs can mitigate physician liability following medical errors.
• However, using CDAs may diminish patient favorability, particularly after positive outcomes.
• Physician reliance on CDAs influences perceptions of competence and accountability.