Working Papers

Behaving Discretely: Heuristic Thinking in the Emergency Department

This paper explores the use of heuristics among highly-trained physicians diagnosing heart disease in the emergency department, a common task with life-or-death consequences. Using data from a large private-payer claims database, I find compelling evidence of heuristic thinking in this setting: patients arriving in the emergency department just after their 40th birthday are roughly 10% more likely to be tested for and 20% more likely to be diagnosed with ischemic heart disease (IHD) than patients arriving just before this date, despite the fact that the incidence of heart disease increases smoothly with age. Moreover, I show that this shock to diagnostic intensity has meaningful implications for patient health, as it reduces the number of missed IHD diagnoses among patients arriving in the emergency department just after their 40th birthday, thereby preventing future heart attacks. I then develop a model that ties this behavior to an existing literature on representativeness heuristics, and discuss the implications of this class of heuristics for diagnostic decision making.

Publications

Olenski, A.R., Zimerman, A., Coussens, S. and Jena, A.B., 2020. Behavioral Heuristics in Coronary-Artery Bypass Graft Surgery. New England Journal of Medicine, 382(8), pp.778-779.

In an analysis of Medicare data, patients hospitalized with acute myocardial infarction 2 weeks after, as compared with 2 weeks before, their 80th birthday were significantly less likely to undergo CABG. This appears to be an example of left-digit bias, which is a behavioral heuristic (a mental shortcut that simplifies decision making).

Selected Work in Progress

Worth the Price of Admission? Evidence from Emergency Department Admissions

Fight the [Statistical] Power: Efficient Treatment Effect Estimation under Imperfect Compliance

Optimally-Weighted Instrumental Variables (with Jann Spiess)

Incorporating Compliance Prediction into RCT Design

Behaving Discretely: Heuristic Thinking in the Emergency Department

This paper explores the use of heuristics among highly-trained physicians diagnosing heart disease in the emergency department, a common task with life-or-death consequences. Using data from a large private-payer claims database, I find compelling evidence of heuristic thinking in this setting: patients arriving in the emergency department just after their 40th birthday are roughly 10% more likely to be tested for and 20% more likely to be diagnosed with ischemic heart disease (IHD) than patients arriving just before this date, despite the fact that the incidence of heart disease increases smoothly with age. Moreover, I show that this shock to diagnostic intensity has meaningful implications for patient health, as it reduces the number of missed IHD diagnoses among patients arriving in the emergency department just after their 40th birthday, thereby preventing future heart attacks. I then develop a model that ties this behavior to an existing literature on representativeness heuristics, and discuss the implications of this class of heuristics for diagnostic decision making.

©2019 by Stephen Coussens.