Reforming Physician Payment Report of a Conference (1984) / Chapter Skim
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Changing Physician Behavior: In Search of the Little Blue Button
Changing Physician Behavior: In Search of the Little Blue Button
Pages 30-43
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From page 30... ...
Where is the little blue button? Five categories of non-economic influences are particularly noteworthy: education, feedback, managerial and organizational constraints, peer pressure, and patient demands.
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From page 31... ...
Organizational settings where physicians are using their professional skills in close proximity to other physicians and where other links may be established among them provide unusually good opportunities to incorporate all three effectively. Patient demands are perhaps less amenable to policy initiatives, but are nonetheless an influence on physician behavior which deserves mention.
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From page 32... ...
A second question posed at the outset was what kinds of physician behaviors should receive attention? It is tempting to distinguish between clinical and non-clinical behavior, and, indeed, much of what has been written uses this distinction either explicitly or implicitly.
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From page 33... ...
The primary findings, of course, are that medical school is a powerful socializing agent, that future physicians are often strongly influenced by faculty role models, and that one consequence is often a devaluing of general practice or primary care and an over-emphasis on specialty practice. Non-clinical professional behavior.
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From page 34... ...
Clinical decision-making. A great deal of research has been done in this arena, primarily because of the potential attributed to changing certain aspects of clinical behavior for controlling the costs of medical care.4 If physicians would order fewer laboratory tests, prescribe fewer drugs, and be less inclined to use expensive technology of questionable efficacy, the aggregate impact on costs would be significant, the argument goes.
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From page 35... ...
Other studies cite the importance of opinion leadership in influencing the clinical behavior of physicians. Perhaps the best-known of these studies focused on patterns of diffusion of a new drug among physicians and discovered that a very few well-respected physicians had an enormous influence on their colleagues.l° These physicians were, in effect, gatekeepers.
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From page 36... ...
It is of ten suggested that because of the early and powerful influence of medical education on subsequent career choices, the most direct and effective way to change physician behavior is to change the structure, context and process of medical education. I do not disagree that such change would be helpful.
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From page 37... ...
Possibilities for linking educational efforts with regular, systematic feedback and capitalizing on the power of peer influence are dramatically enhanced when physicians are working in close proximity and are sub ject to a common admi nistrat ive system, no matter how loosely or tightly def ined that system may be. Enough is known about designing education and performance feedback systems and about capitalizing on the power of peer pressure to permit policy initiatives to take advantage of the increasingly organized character of the practice of medicine.
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From page 38... ...
The basic point is that the inf luence of the patient on physician behavior is substantial and its potential ought to be incorporated into thinking about policy options. To summarize, the most signif icant non-economic influences on physician behavior are education, feedback, peer pressure, managerial and organizational constraints and patient demands.
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From page 39... ...
Environmental Changes There is no need here to rehearse the myriad changes that are taking place in the environment of medicine.l7 Of particular interest is the increase in the supply of physicians J the increasing application of the logic of managerial efficiency to the work that health professionals do, the proliferation of organizations as the shone baser for physicians, the infusion of private capital into the health care industry, and the growth of multi-institutional arrangements of many sorts linking previously independent, autonomous health care providing institutions one to another. Opinions differ on the desirability of many of these changes, a fact which surprises no one.
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From page 40... ...
At any given time the population of physicians includes people who are at very dif ferent points in the development of thei r professional careers and personal ambitions. It would be unrealistic to assume, therefore, that this population would respond with anything 1 Ike uniform)
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From page 41... ...
To focus exclusively on clinical behavior is to focus on one arena and perhaps to ignore or underestimate the power of other arenas and how they do or do not fit together as shapers of motivation and behavior. The increasing supply of physicians, the increased emphasis on productive efficiency, and the increasingly organized character of much of medical practice will change the way in which the physician views the ex ist ing opportunity structure.
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From page 42... ...
Journal of Medical Education, 54:856-862, 1979; Eisenberg, JaMe and Williams, S.V., Cost containment and changing physicians' practice behavior. Journal of the American Medical Association, 246 2195 - 22O1J 1981e 5.
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From page 43... ...
Discrepancies between knowledge and use of diagnostic studies in asymptomatic patients.. Journal of Medical Education, 54:863-869, 1979.
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