Abstract
The medical consultation is best understood as a two-way social interaction involving interactive decision making. Game theory—a theory based on assumptions of rational choice and focusing on interactive decision making—has the potential to provide models of the consultation that can be used to generate empirically testable predictions about the factors that promote quality of care. Three different game structures—the Prisoner’s Dilemma game, the Assurance game, and the Centipede game—all provide insights into the possible underlying dynamics of the doctor-patient interaction. Further empirical work is needed to uncover the underlying game structures that occur most commonly in medical consultations. Game theory has the potential to provide a new conceptual and theoretical basis for future empirical work on the interaction between doctors and their patients.
Highlights
The medical consultation is best understood as a two-way social interaction
This review has indicated that game theory can be applied to the medical consultation and used to generate predictions about how the context of a doctor-patient interaction influences cooperation and quality of care
We have given intuitive examples of how game theory models might apply to the medical consultation, but empirical work to identify and develop appropriate game theoretic models of the medical consultation would be of great value, and would open up further possibilities for the use of applied game theory in consultation research
Summary
Models of the medical consultation: opportunities and limitations of a game theory perspective. Game theory—a theory based on assumptions of rational choice and focusing on interactive decision making—has the potential to provide models of the consultation that can be used to generate empirically testable predictions about the factors that promote quality of care. The unique Nash equilibrium in the Prisoner’s Dilemma game is joint defection (D, D), with both prisoners disclosing information This is because D is a best reply for both players in the sense that it yields a better outcome to each individual than cooperating, whether the co-player chooses to cooperate or to defect. Prisoner’s Dilemma and the consultation With reasonable simplifying assumptions, medical consultations in primary care may have an underlying structure that corresponds to the Prisoner’s Dilemma game In any consultation it is possible for the doctor either to act in the patient’s best interests (C) or (whether through error, misjudgement, lack of skills, or conflicting goals) to take a course of action that is not in the best interests of the patient (D), leading to poor quality care. N (C, C): the doctor spends time giving advice; the patient chooses to follow the advice
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