Benjamin R. Roman, MD, MSHP; David A. Asch, MD, MBA
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0212.
Roman B., Asch D.; The Challenge of Deadopting Low-Value Care. Ann Intern Med. 2014;161:843. doi: 10.7326/L14-5031-2
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Published: Ann Intern Med. 2014;161(11):843.
We agree with Dr. Schwartz that high costs have many origins. However, our main point was that addressing medical overuse will require more than just setting new standards of appropriateness and providing education and guidance to reach those standards. Our difficulty giving up low-value services arises less because physicians might be self-interested or socialized toward the wrong goals and more because physicians are human and susceptible to characteristically human errors in thinking. These include optimism bias, confirmation bias, loss aversion, the affect heuristic, and perhaps other decision processes that are not the products of reason but reflections of our psychological foibles.
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