ABSTRACT
So what are these “other factors” that lead physicians to overprescribe when they are uncertain about a patient’s condition? They have to do with the prevailing culture among physicians, what I have called context or labeling in the operant learning of animals. In humans, as in animals, the type of reinforcer matters. For example, one of the very best hospitals in the world is the Mayo Clinic in Rochester, Minnesota. It also boasts one of the lowest costs in the country-$8,000 less per capita than McAllen, according to Gawande, and in the bottom 15% for the country. The culture at Mayo is collaborative and patient centered-and doctors are paid a salary. In other words, an individual Mayo doctor gains nothing fi nancially from prescribing treatment versus no treatment, or one treatment versus another. His reinforcements are social, from success in curing patients and via collaboration with other doctors, rather than pecuniary.
