Do physicians value decision support? A look at the effect of decision support systems on physician opinion

Clinical decision support systems are on the verge of becoming routine software tools in clinical settings. We investigate the question of how physicians react when faced with decision support suggestions that contradict their own diagnoses. We used a study design involving 52 volunteer dermatologists who each rated the malignancy of 25 lesion images on an ordinal scale and gave a dichotomous excise/no excise recommendation for each lesion image. After seeing the system's rating and excise suggestions, the physicians could revise their initial recommendations. We observed that in 24% of the cases in which the physicians' diagnoses did not match those of the decision support system, the physicians changed their diagnoses. There was a slight but significant negative correlation between susceptibility to change and experience level of the physicians. Physicians were significantly less likely to follow the decision system's recommendations when they were confident of their initial diagnoses. No differences between the physicians' inclinations to following excise versus no excise recommendations could be observed. These results indicate that physicians are quite susceptible to accepting the recommendations of decision support systems, and that quality assurance and validation of such systems is therefore of paramount importance.