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Physicians' Anticipated Regret and Diagnostic Testing: Comment on Hozo and Djulbegovic, 2008

In a recent article in this journal, Hozo and Djulbegovic 1 (hereafter H&D) extended their previous work on ‘‘acceptable regret’’ 2 to situations in which diagnostic tests are available. They described a model in which physicians’ levels of acceptable regret affect the probability ranges over which 3 decision alternatives (order a diagnostic test, treat without testing, or withhold treatment without testing) are considered rational and appropriate, and they illustrated the model with an example involving a patient suspected of having a pulmonary embolism (PE). This commentary addresses several issues related to physicians’ regret and diagnostic testing. The first 2 sections concern the 2 components of H&D’s model: expected regret and acceptable regret. The third section sketches an alternative approach that draws more heavily on regret theory 3,4 and the effects of physicians’ anticipated malpractice liability on decision thresholds. 5 The final section points out that physicians’ gains from regret reduction are obtained at the expense of patients’ expected utilities.