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Open Questions Concerning Influences on Clinical Decision Making

Davidson, Stephen M. PhD

The Journal of Ambulatory Care Management: April/June 2013 - Volume 36 - Issue 2 - p 88–107
doi: 10.1097/JAC.0b013e31828596de
Original Articles

Efforts to influence utilization of services to bring down spending and to improve quality of care have largely failed. A critical reason is that most attention has focused on dysfunctional financial incentives without considering other factors that also influence physicians' utilization decisions. In this article, after providing a framework for ideal physician-patient interactions, questions are also raised about other influences, including physicians' impulse to help patients, professional codes of ethics, the threat of malpractice claims, and the leadership of health care organizations. An Appendix contains a summary of the literature on these factors.

Boston University School of Management, Boston, Massachusetts.

Correspondence: Stephen M. Davidson, PhD, Boston University School of Management, 595 Commonwealth Ave, Boston, MA 02215 (

The author has disclosed that he has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2013 Lippincott Williams & Wilkins, Inc.