The Patient’s Dilemma: An approach in Medical Decision Making using the Prisoner’s Dilemma Model and the Prospect Theory

Abstract

Prospect theory suggests that when people are faced with uncertain outcome, they may be risk seeking or aversive, depending on the utility value. While Prisoner’s dilemma shows that suboptimal choices are made if people seek their own gain only. Patients’ demand in decision making during the recent years evolved this dilemma. Through a mathematical approach and survey, the doctor-patient involvement in decision making has been explored. A hypothetical model was created simulating the Prisoner’s dilemma to show patient would make sub-optimal choices. In a comparative study that considered Prospect Theory, 50 doctors and 50 non-doctors were asked to answer questions that involved their decision making. The patient’s dilemma arises when choosing between two doctors who have similar cure rates. The decisions of non-doctors were similar to doctors in most of the questions. The difference arose, when comparing two hypothetical doctors, one of whom had a slight better cure rate but had less experience; significantly more doctors (66%) chose the experienced (but with less success rate) doctor for their own treatment, than non-doctors (42%). The chi-square statistic being 4.6517 with p-value .031024, result was significant at p<.05. We can conclude, optimal decision cannot be obtained if either of the participant’s decision is ignored. Doctors use heuristics, while patients (non-doctors) can be more rational in their approach. So, decision making should be shared.

Keywords: Medical decision making, patient’s dilemma, prisoner’s dilemma, prospect theory