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Record W4417516426 · doi:10.1162/rest.a.1686

Discretion in Clinical Decision Making: Evidence from Bunching

2025· article· en· W4417516426 on OpenAlexaff
Claire Boone

Bibliographic record

VenueThe Review of Economics and Statistics · 2025
Typearticle
Languageen
FieldHealth Professions
TopicHealth Policy Implementation Science
Canadian institutionsMcGill University
Fundersnot available
KeywordsDiscretionMicrodata (statistics)HeuristicEstimationHealth careVariation (astronomy)

Abstract

fetched live from OpenAlex

Abstract Should healthcare providers strictly adhere to clinical guidelines, or is some discretion beneficial? Using bunching estimation and microdata from 619,907 patients in Chile, I examine discretion in the diagnosis of hypertension (blood pressure ≥ 140/90mmHg). I find bunching in blood pressure at 10% of clinics, where 6 to 62% of patients' test results expected just above the hypertension diagnostic threshold are instead recorded just below it, suggesting providers use their discretion to consider some tests false positives. Leveraging variation in bunching across clinics, I show that affected patients have lower cardiovascular risk, suggesting discretion improves patient classification, partially driven by heuristic thinking.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame distilled prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.

metaresearch head score (Codex)0.006
metaresearch head score (Gemma)0.006
Version: codex-gemma-dda1882f352aValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Other design · Consensus signal: none
GenreCandidate signal: Review · Consensus signal: none
Teacher disagreement score0.803
Threshold uncertainty score0.748

Codex and Gemma teacher scores by category

CategoryCodexGemma
Metaresearch0.0060.006
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0000.000
Bibliometrics0.0000.000
Science and technology studies0.0000.000
Scholarly communication0.0000.000
Open science0.0000.000
Research integrity0.0000.000
Insufficient payload (model declined to judge)0.0000.000

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.542
GPT teacher head0.695
Teacher spread0.153 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one teacher head, not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designOther design
Domainnot available
GenreReview

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations1
Published2025
Admission routes1
Has abstractyes

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