Behaving Discretely: Heuristic Thinking in the Emergency Department

  title={Behaving Discretely: Heuristic Thinking in the Emergency Department},
  author={Stephen Coussens},
  journal={PSN: Health Care Delivery (Topic)},
This paper explores the use of heuristics among highly-trained physicians diagnosing heart disease in the emergency department, a common task with lifeor- death consequences. Using data from a large private-payer claims database, I find compelling evidence of heuristic thinking in this setting: patients arriving in the emergency department just after their 40th birthday are roughly 10% more likely to be tested for and 20% more likely to be diagnosed with ischemic heart disease (IHD) than… 
What Difference Does a Diagnosis Make? Evidence from Marginal Patients
It is found that a marginally diagnosed patient with diabetes spends $1,097 more on drugs and diabetes-related care annually after diagnosis, but find no corresponding changes in self-reported health or healthy behaviors, as well as other clinical measures of health, which show no improvement.
Behavioral Effects of Insurance Coverage and Health Consequences: Evidence from Long-Term Care
How does the generosity of social insurance coverage affect demand for healthcare and health outcomes of elderly people? This paper examines the effects of insurance coverage on long-term care
The Heuristics of Obesity: Influences on Physician Decision-Making
Age-Based Left-Digit Bias in the Management of Acute Cholecystitis
The role of left-digit bias in the management of older patients with cholecystitis was assessed to characterize the role of cognitive biases on clinical decision-making among patients undergoing coronary artery bypass graft surgery.


Missed diagnoses of acute cardiac ischemia in the emergency department.
The percentage of patients who present to the emergency department with acute myocardial infarction or unstable angina who are not hospitalized is low, but the discharge of such patients is associated with increased mortality.
Chest pain in the emergency room: value of the HEART score
  • A. Six, B. Backus, J. Kelder
  • Medicine
    Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
  • 2008
The HEART score is an easy, quick and reliable predictor of outcome in chest pain patients and facilitates accurate diagnostic and therapeutic choices.
Clinical decision support systems could be modified to reduce 'alert fatigue' while still minimizing the risk of litigation.
It is found that more finely tailored or parsimonious warnings could ease alert fatigue without imparting a high risk of litigation for vendors, purchasers, and users.
How Doctors Think
  • Chenjie Xia
  • Computer Science
    McGill Journal of Medicine : MJM
  • 2008
In his latest book, How Doctors Think, Dr. Groopman takes the readers on a tour of a wide range of medical fields while jumping swiftly back-and-forth between the physician and the patient's perspective, and highlights the risk of overlooking important subtleties, nuances and ambiguities in a patient’s illness.
Medicine's uncomfortable relationship with math: calculating positive predictive value.
In 1978, Casscells et al1 published a small but important study showing that the majority of physicians, house officers, and students overestimated the positive predictive value (PPV) of a laboratory
Interpretation by physicians of clinical laboratory results.
A small survey was conducted to obtain some idea of how physicians do, in fact, interpret a laboratory result, and asked if a test to detect a disease whose prevalence is 1/1000 has a false positive rate of .
Changes in the Source of Unscheduled Hospitalizations in the United States
Sources of unscheduled hospitalization in the United States have evolved, mostly resulting from care for a variety of clinical conditions now originating in the ED, and this trend does not seem to be harming patients or worsening LOS.
After Midnight: A Regression Discontinuity Design in Length of Postpartum Hospital Stays
It is found that children born just prior to midnight have significantly shorter lengths of stay than those born just after midnight, despite similar observable characteristics, and that for uncomplicated births, longer hospitals stays incur substantial costs without apparent health benefits.
The growing role of emergency departments in hospital admissions.
Growing use of U.S. emergency departments, cited as a key contributor to rising health care costs, has become a leading target of health care reform. Since 1993, emergency departments have played an
Human Decisions and Machine Predictions
While machine learning can be valuable, realizing this value requires integrating these tools into an economic framework: being clear about the link between predictions and decisions; specifying the scope of payoff functions; and constructing unbiased decision counterfactuals.