title: Personal view: passing the buck and taking a free ride -- a game-theoretical approach to evasive management strategies in gastroenterology.
abstract: BACKGROUND
  'Free-riding' physicians enjoy the status, prestige and income of their profession without fully contributing to its overall mission. By shifting the costs of potential medical complications and difficult patient encounters to other physicians, they reap the benefits of their profession without carrying its full weight.
  
  
  OBJECTIVE
  To describe this phenomenon in terms of decision analysis and characterize the parameters affecting its occurrence.
  
  
  METHODS
  The interaction between two physicians is modeled as a non-zero-sum game. Two strategies of either contributing to patient management or taking a free ride are available to both physicians. The four possible outcomes are arranged in a two-by-two game matrix.
  
  
  RESULTS
  Physicians practice medicine because their personal benefit exceeds their cost. High cost to the physician results in a high probability of taking a free ride and copping out from potentially risky management. Increasing the benefit decreases the probability of free riding. As the number of possible encounters with other physicians increases, the probability of free riding increases and the probability for effective management by each individual physician decreases.
  
  
  CONCLUSIONS
  If individual gastroenterologists felt less threatened by administrative repercussions and medico-legal consequences of untoward events, each one of them would contribute more to effective patient management.
authors.affiliation: Department of Gastroenterology, Portland VA Medical Center, Oregon Health and Science University, Portland, 97239, USA. sonnenbe@ohsu.edu
authors.forename: A
authors.initials: A
authors.lastname: Sonnenberg
mesh_terms: D002983:Clinical Competence; D003657:Decision Making; D019468:Disease Management; D005260:Female; D005716:Game Theory; D005767:Gastrointestinal Diseases / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'