Behaving Discretely: Heuristic Thinking in the Emergency Department

Abstract

This paper explores the use of heuristics among highly-trained physicians diagnosing heart disease in the emergency department, a common task with lifeor- 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.