How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China
Abstract Background Diagnostic errors remain a pressing challenge in health systems with uneven provider capacity and limited diagnostic standardization. In such environments, cognitive biases, particularly anchoring effect, may compromise diagnostic independence and reinforce structural disparities...
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BMC
2025-08-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-025-13265-9 |
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| author | Jie Yang Junhao Wu Yuyang Xie Yuchen Meng Jun Chen Jianmin Ai Jingchun Nie Caimei Bai Yaojiang Shi |
| author_facet | Jie Yang Junhao Wu Yuyang Xie Yuchen Meng Jun Chen Jianmin Ai Jingchun Nie Caimei Bai Yaojiang Shi |
| author_sort | Jie Yang |
| collection | DOAJ |
| description | Abstract Background Diagnostic errors remain a pressing challenge in health systems with uneven provider capacity and limited diagnostic standardization. In such environments, cognitive biases, particularly anchoring effect, may compromise diagnostic independence and reinforce structural disparities in care quality. Methods We conducted a randomized field experiment in western China using standardized patients (SPs) to examine how prior spectacle diagnostic prescriptions influence the behavior and accuracy of second-opinion optometrists. SPs visited optical providers in Shaanxi province, presenting either no prior prescription, a correct one, or an incorrect one. Diagnostic outcomes were evaluated against gold-standard prescriptions issued by an expert ophthalmologist. Results Exposure to prior prescriptions, especially inaccurate ones, significantly reduced diagnostic accuracy and process completeness. Providers given prior diagnoses were less likely to conduct key tests and spent less time on examinations, suggesting reliance on cognitive shortcuts. These findings provide field-based evidence of anchoring bias in real-world clinical settings. Conclusions Prior diagnostic information can shape second-opinion decision-making through cognitive anchoring, particularly in systems lacking strong institutional protocols. Addressing these biases through structured diagnostic procedures and provider training may enhance diagnostic accuracy and promote greater equity in vision care delivery. |
| format | Article |
| id | doaj-art-43c322debe1b4c8b9c57e69af3ef4b9b |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-43c322debe1b4c8b9c57e69af3ef4b9b2025-08-20T03:45:56ZengBMCBMC Health Services Research1472-69632025-08-012511910.1186/s12913-025-13265-9How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western ChinaJie Yang0Junhao Wu1Yuyang Xie2Yuchen Meng3Jun Chen4Jianmin Ai5Jingchun Nie6Caimei Bai7Yaojiang Shi8Center for Experimental Economics in Education, Faculty of Education, Shaanxi NormalCenter for Experimental Economics in Education, Faculty of Education, Shaanxi NormalCenter for Experimental Economics in Education, Faculty of Education, Shaanxi NormalCenter for Experimental Economics in Education, Faculty of Education, Shaanxi NormalCenter for Experimental Economics in Education, Faculty of Education, Shaanxi NormalCenter for Experimental Economics in Education, Faculty of Education, Shaanxi NormalCenter for Experimental Economics in Education, Faculty of Education, Shaanxi NormalCollege of Physical Education, Shaanxi Xueqian Normal UniversityCenter for Experimental Economics in Education, Faculty of Education, Shaanxi NormalAbstract Background Diagnostic errors remain a pressing challenge in health systems with uneven provider capacity and limited diagnostic standardization. In such environments, cognitive biases, particularly anchoring effect, may compromise diagnostic independence and reinforce structural disparities in care quality. Methods We conducted a randomized field experiment in western China using standardized patients (SPs) to examine how prior spectacle diagnostic prescriptions influence the behavior and accuracy of second-opinion optometrists. SPs visited optical providers in Shaanxi province, presenting either no prior prescription, a correct one, or an incorrect one. Diagnostic outcomes were evaluated against gold-standard prescriptions issued by an expert ophthalmologist. Results Exposure to prior prescriptions, especially inaccurate ones, significantly reduced diagnostic accuracy and process completeness. Providers given prior diagnoses were less likely to conduct key tests and spent less time on examinations, suggesting reliance on cognitive shortcuts. These findings provide field-based evidence of anchoring bias in real-world clinical settings. Conclusions Prior diagnostic information can shape second-opinion decision-making through cognitive anchoring, particularly in systems lacking strong institutional protocols. Addressing these biases through structured diagnostic procedures and provider training may enhance diagnostic accuracy and promote greater equity in vision care delivery.https://doi.org/10.1186/s12913-025-13265-9Second medical opinionDiagnostic accuracyRandomized field experimentCognitive biasStandardized patients |
| spellingShingle | Jie Yang Junhao Wu Yuyang Xie Yuchen Meng Jun Chen Jianmin Ai Jingchun Nie Caimei Bai Yaojiang Shi How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China BMC Health Services Research Second medical opinion Diagnostic accuracy Randomized field experiment Cognitive bias Standardized patients |
| title | How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China |
| title_full | How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China |
| title_fullStr | How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China |
| title_full_unstemmed | How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China |
| title_short | How prior spectacle prescriptions shape diagnostic behavior: evidence from a randomized field experiment on vision care in Western China |
| title_sort | how prior spectacle prescriptions shape diagnostic behavior evidence from a randomized field experiment on vision care in western china |
| topic | Second medical opinion Diagnostic accuracy Randomized field experiment Cognitive bias Standardized patients |
| url | https://doi.org/10.1186/s12913-025-13265-9 |
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