Has the Doctor-Patient Relationship Become a "Prisoner’s Dilemma"?

The self-interested choices of the patient and the doctor frequently causes bad outcomes in healthcare, either overtreatment or under treatment. According to a team of physicians and a mathematician, treatment decision mistakes are made 42% of the time due to such conflicting interests. The team argued in the European Journal of Clinical Investigation that trust is eroding and conflicting incentives risk corrupting healthcare by motivating a domino effect of poor healthcare outcomes. A healthcare system where doctors are more incentivized to cut costs and uphold their reputation than they are incentivized to produce quality care for their patients. 

If two arrested bank robbers stay silent instead of ratting the other out, they both get a lesser charge. If one rats out the other, one will get out and the other will serve time. If they both betray each other, they will both go to jail. This is the 'prisoner's dilemma' that the most self-interested choice is to rat out their partner, but two people who act in their own self-interest end up each doing something that makes them both worse off.

Researchers likened this dilemma in a doctor's office, where a patient might seek opiods for pain. If he has real pain, it would be rational for the doctor to treat him. Regardless of whether the patient needs opioids, the doctor will prescribe them to avoid the patient giving him a low satisfaction score, which would result in loss of reputation and reduced income. The current healthcare system is constantly trying to cut costs and improve health. However, there is major concern that these initiatives are placing the interests of patients and doctors in conflict, which produces a 'prisoner's dilemma' in healthcare where everyone is worse off than before. 

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