Why are you doing this: a dual-process-model-based clinical decision-making framework for diagnostic test ordering

Many interventions were conducted to reduce unnecessary diagnostic tests. Although the interventions proved effective, the sustainability of the interventions was questionable. In order to understand why clinicians over-order and design sustainable interventions, it is imperative to investigate clinician’s decision-making process of diagnostic test ordering. This research aims to establish a relation between clinician’s decision-making patterns with clinician experience and patient complexity by adopting dual process theory (DPT) from behavioral economics as the theoretical foundation. DPT holds that human decisions are made by two systems, fast and skilled System 1 and slow and analytical System 2. The contributions in our study are clinical decision-making models and framework for diagnostic test ordering. The clinical decision-making models depict different cognitive pathways of System 1 and System 2. The framework highlights the patient complexity and clinician’s experience level as potential factors to influence the reasoning mode about ordering a diagnostic test.