| Abstract: |
We study how situational fluctuations in cognitive capacity shape behavior in
high-stakes, real-time decision-making. Drawing on recent advances in
behavioral economics that revolve around inattention, cognition and
complexity, we show that cognitive load influences how physicians in emergency
departments allocate mental effort and attention when making diagnostic and
treatment decisions. We use quasi-random variation in patient-physician
pairings, along with granular electronic medical record and audit-log data
from many clinical interactions, to show that, under higher cognitive load,
physicians substitute mental deliberation with more numerous but less precise
diagnostic actions. Specifically, we document that higher load (i) increases
the total number of orders of diagnostic tests (ii) reduces the use of
targeted, but more uncommon tests (iii) increases the use of common tests and
(iv) increases uncertainty in diagnostic beliefs. Cognitive load impacts
downstream inpatient admission from the emergency department: a physician in
the highest cognitive load decile increases admissions by 28% relative to the
same physician in the lowest cognitive load decile, for the exact same kind of
patient. These results offer novel field-based evidence on the dynamics of
attention and belief formation, and shed light on how cognitive constraints
shape diagnostic behavior in complex, real-world environments. |