The Doctor-Patient Dilemma
Game theory can be applied to nearly every facet of society that requires interpersonal interaction. Delving into deeper social studies, strategic maintenance in relationships is a norm. Unfortunately, a facet that we like to think less of as “strategic”, but may have prevalent bases in game theory strategies more than we realize is the medical exchange between the doctors and patients. Parallels between the Prisoner’s Dilemma and doctor-patient relationships reveal that it is the dominant strategy of a physician to treat a patient and prescribe medication, regardless of whether the patient’s claimed pain is genuine or not.
The dilemma stands as this: A patient seeking opioids for pain maintenance could either truly need it ethically to relieve pain or could be asking to reconcile drug addiction. A doctor decides whether to prescribe opioid medication or to refuse to do so. If the patient’s pain is real, it is in the best interest of the doctor to prescribe the medication, as any doctor has vowed in the Hippocratic Oath to treat illness. If the patient’s pain is fake, it still remains in the doctor’s best interest to prescribe the medication, in order to avoid low satisfaction rates and reviews that could potentially harm his/her career. As such, regardless of whether the patient’s pain is real or fake, the doctor should prescribe the medication. If this is done, the patient has received requested treatment and the doctor can move onto the next patient, leaving both parties satisfied. The article criticizes that may not be a solution at all: “The drugs don’t address the patient’s problem, and the prescription contributes to a global crisis of emerging superbugs triggered by the overuse of antibiotics.”
This “dilemma” is an unfortunate flaw in the system, as well as the cornerstone of arguments against the circulation of abusive drugs forged in private arenas (distribution via private-practice doctors). It is corrupt that physicians who refuse to provide treatment on ethical bases risk their professions, reputations, and incomes. The article claims that the incentives of doctors have shifted in order to combat pressures to reduce rising health care prices and to to respond to evaluation from all around. “The revolution underway in the health care system is supposed to cut costs and improve health, but [the concern is] that these may put the interests of patients and doctors in conflict, creating the prisoner’s dilemma.” In order to ameliorate this corruption, incentives need to be shifted back to one that is patient’s-health-focused. To spark change in this doctor-patient “game,” one must find a way to separate a doctor’s practice from the reviews which s/he service receives. This may very well may be impossible, as reviews are direct reflections of an individual’s performance. However, like the judiciary system is run in this country, where everything is done to preserve the neutrality of Supreme Court judges, a physician needs to feel safe enough to prescribe the proper treatment, without fear of self-sacrifice in endangering his/her own livelihood.