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Accountability Bias: Reason why HCPs order too many tests!

Behavioral science explains how an epidemic of over-intervention in healthcare is driving healthcare costs through the roof.
ImageNewristics Image10 February 2020

Playing defense with decision-making heuristics

Accountability Bias is seen when a person thinks he might have to justify a decision to another person or group. This concept is closely linked to defensive decision-making, wherein a person knowingly chooses a suboptimal course of action because he will be better protected in an event where something goes wrong. 


Consider prostate interventions. Most prostate cancers will remain nonprogressive throughout the lifetime of most men. While screening may detect prostate cancers, the cancers detected are most likely benign. In other words, men are more likely to die with prostate cancer than as a result of it.

Physicians, however, often err on the side of over-intervention. Why? A primary reason is that they don’t want to risk being put in a position where they detected potential cancer and didn’t act on it; this can become particularly hazardous because they open themselves up to liability in the event of a lawsuit.

A case in point is a physician telling his friend not to get a prostate screening but advising a patient to get the screening done. A simple case of Accountability Bias comes into play since the physician might have to justify his decision to a group of doctors or in court.

Pros and cons of defensive decision-making

While the above example seems like a no-brainer, over-intervention means more men are treated for prostate cancer. The problem with biased decision-making is it removes rational thinking from the equation and mental shortcuts call the shots. Whether a physician recommending prostate cancer screenings or an account manager who will have to justify her hiring decisions to her manager, this bias suppresses one’s personal views and self-interests.

Again, this sounds like a good thing, and it can be. In some scenarios, it could reduce discrimination and favoritism, but at the same time, it doesn’t allow the individual to grow and exert autonomy. For an expert or novice alike, the ability to take risks and draw from experience, research, or even gut instincts, has the potential to drive imaginative solutions.

Ways to make better decisions based on rational thinking

As we can see, Accountability Bias has its pros and cons. We wouldn’t want to go through life with no sense of accountability for our actions! However, in order to get the best possible outcomes and achieve growth, it can be helpful to suppress our defensive decision-making and think through the choice.

Start with 3 easy methods to make more informed decisions:

  1. Slow down and avoid rushing important decisions.
  2. Take the time to research all available decisions and gain an understanding of their various benefits and disadvantages.
  3. Make choices that align with your beliefs, values, and goals, while maintaining the best interest of the other party or organization.

Defending our decisions is important to avoid costly mistakes that can harm our reputation or bottom line, but don’t let it come at the cost of your own opinion of yourself.

[1] 1 in 5 American men in their 50s, about will have prostate cancer. When these men are in their 60s and 70s, two to three are anticipated to have prostate cancer. This number jumps to 4 out of 5 men in their 80s. Yet the lifetime risk of dying from prostate cancer is 3%.

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