Why Do Physicians Order More Tests?

Why Do Physicians Order More Tests?

MRIs, CT scans, or blood tests ordered for patients… These are tools physicians frequently use to make a diagnosis, plan treatment, or predict risks. However, sometimes these tests can be ordered unnecessarily or, conversely, necessary ones can be overlooked. The issue here is actually a decision-making process. And the decision here isn't solely dependent on the patient's complaints or the course of the disease. The physician's mental state, current circumstances, and even the number of patients waiting can also play a role.

Being a physician isn't easy, especially when decisions are made against time. The patient is listened to, examined, notes are taken, and finally, a decision is made: Will tests be ordered or not? This decision is, of course, based on medical knowledge, experience, and the patient's condition. But is that all? Factors such as how many patients the physician will be seeing during the day, how many patients they've seen so far, and what time of day they perform their examinations can also come into play. The research conducted by Ayşe Kocabıyıkoğlu from Sabancı University, Evrim Didem Güneş from Koç University, Büşra Ergün-Şahin from the University of Bedfordshire, and Ahmet Keskin from Yıldırım Beyazıt University focuses on exactly this point: How much does workload affect a physician's decision to order a test?

Unfinished workload, finished workload: Which workload is more effective?

The study divides physicians' workload into two categories: unfinished workload, meaning patients waiting in line, and finished workload, meaning the number of patients a physician has seen so far. The researchers examined how these two types of workload influence test-ordering decisions. The data is from the internal medicine outpatient clinic of a large public hospital in Ankara. More than 80,000 patient records were examined between January 2015 and December 2016. So, we're talking on solid ground.

The more patients waiting, the more likely physicians are to request a test.

The research results are clear: As the number of patients waiting in front of a physician increases, the likelihood of requesting a test also increases. However, this increase doesn't significantly change the number of tests per patient. In other words, physicians prescribe more tests for more patients to shorten the queue, but they continue to prescribe the same number of tests for each. The researchers explain this as follows: When physicians see a crowd waiting, they speed up, shorten the time they allocate to patients, and therefore, conduct more tests during the diagnostic process. So, the test becomes a time-saving tool.

The number of tests decreases as the day progresses.

As the number of patients a physician sees increases from the beginning of the day—in other words, as their "finished workload" increases—a different trend emerges: the number of tests prescribed for patients decreases. For example, a physician who might prescribe four tests for a patient in the morning might end up administering only one later in the day. Researchers believe this is due to physical fatigue and mental exhaustion. As the mind becomes tired, physicians can consider fewer diagnostic options, which translates to fewer tests.

The number of tests decreases as examination time shortens.

The study looked not only at workload but also at the examination time itself. The findings indicate that as the time a physician spends on a patient decreases, both the likelihood of ordering tests and the number of tests ordered decrease. In other words, fewer tests are ordered as the day progresses. Why? The researchers offer several possible explanations for this: the likelihood of more severe cases arriving in the morning, increased fatigue throughout the day, and perhaps the ease with which tests ordered in the morning can be processed on the same day. In short, not only physician fatigue but also the functioning of the system may play a role in these decisions.

Our decisions depend not only on information but also on operational conditions.

This research reveals that healthcare services are shaped not only by "medical considerations" but also by "operational realities." Factors such as physician workload, fatigue, and time pressure directly impact diagnostic processes and test requests. Therefore, to provide better care without increasing quality and costs in healthcare systems, it is essential to consider such "human" factors.

Ergün‐Şahin, B., Güneş, E. D., Kocabıyıkoğlu, A., & Keskin, A. (2022). How does workload affect test ordering behavior of physicians? An empirical investigation. Production and Operations Management, 31(6), 2664-2680

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Link for the professor's biography and other research: 

Ayşe Kocabıyıkoğlu

https://sbs.sabanciuniv.edu/tr/faculty-members-research-area/2707

https://scholar.google.com/citations?user=c7TTivwAAAAJ&hl=tr&oi=ao

Yazının orijinalini Yönetim Bilimleri Fakültesi’nin “Veriden Değere” bülteninde okuyabilirsiniz: 

Prepared for publication by: Ceyda Sinağ
You can read the original article in the Faculty of Management Sciences' "From Data to Value" newsletter.