Plasma proteomic profile of inflammatory depressive symptoms.

Heuristics, or rules of thumb, are hypothesized to influence the care physicians deliver. These heuristics include the availability heuristic, under which the assessment of an event’s likelihood is influenced by how easily the event can be recalled. It is thought to be one of the most common heuristics influencing physician decisionmaking. Recent diagnoses seen may be particularly salient to physicians. However, literature regarding heuristics affecting physician decisionmaking is largely limited to case vignettes, small samples of patients, or small-scale experiments. Some studies that have examined the influence of heuristics using large databases have found evidence consistent with the availability heuristic after adverse events—that is, physicians changing their behavior after adverse events. We are not aware of other literature examining heuristics in complex testing decisions using clinically rich electronic health record data containing information such as time-stamped vital signs and testing. In this study, we used national Veterans Affairs (VA) electronic health record data from 2011 to 2018 to examine a common, high-risk clinical scenario: assessing patients in the emergency department (ED) with shortness of breath for the risk of pulmonary embolism. We examined whether physicians who recently had a patient with a pulmonary embolism diagnosis were more likely to test their subsequent patients for pulmonary embolism, controlling for pulmonary embolism risk factors found in the electronic health record, such as tachycardia, cancer history, and recent surgery. In sensitivity analyses, we then examined whether physician rates of pulmonary embolism testing changed after an unrelated diagnosis (pneumothorax) and whether rates of testing for conditions unrelated to pulmonary embolism changed after seeing a patient with pulmonary embolism. Our VA setting allows us to reduce the influence of malpractice concerns because VA physicians cannot be sued in civil court for a malpractice claim.