title: Personal view: victim blaming as management strategy for the gastroenterologist--a game theoretical approach.
abstract: BACKGROUND
  A multitude of digestive diseases elude simple management strategies. Rather than admit failure of disease management, a gastroenterologist could resort to blaming patients for their own medical conditions. Blaming the patient constitutes an easy exit strategy for otherwise unsolvable disease conditions.
  
  
  OBJECTIVE
  To shed light on the problem of patient blaming in gastroenterology and provide means for its resolution.
  
  
  METHODS
  The interaction between physician and patient can be formulated in terms of a non-zero-sum game between two adversaries. The outcomes associated with two behavioural strategies available to both adversaries are arranged in a two-by-two game matrix.
  
  
  RESULTS
  Blaming the patient is characterized by the general game pattern of the 'prisoner's dilemma'. If the physician-patient interaction is restricted to one single event, patient blaming represents the management strategy of choice with the highest expected payoff under all foreseeable circumstances. If there is a high probability for repeated physician-patient interactions, however, a physician admitting and a patient accepting the limits of medical performance yield a dominant strategy.
  
  
  CONCLUSIONS
  Only for single physician-patient encounters does a non-cooperative strategy of blaming one's adversary for a poor medical outcome yield the highest expected outcome. In the long run, the strategy of shifting blame becomes unproductive for both sides alike.
authors.affiliation: Portland VA Medical Center and Oregon Health & Science University, Portland, OR 97239, USA. sonnenbe@ohsu.edu
authors.forename: A
authors.initials: A
authors.lastname: Sonnenberg
mesh_terms: D001291:Attitude of Health Personnel; D003163:Competitive Behavior; D005716:Game Theory; D005767:Gastrointestinal Diseases / Q000523:psychology*; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology; D008960:Models, Psychological; D010817:Physician-Patient Relations