It is usually believed that peer pressure ends when a person becomes an adult. But this is, unfortunately, not the case. Adults are just as much subject to peer pressure as children and youth. Peer pressure is when a person or group of people attempts to cause another person to conform to some type of uniform code. Peer pressure among adults can happen anywhere, even at workplace and in general work practices.
A new study published in the journal Medicine has shown that peer pressure among emergency physicians (EPs) plays an important role in the use of computed tomography (CT) imaging, also known as CT scan, for dizziness or vertigo patients. A team comprising researchers from Kaohsiung Chang Gung Memorial Hospital, Niao-Sung, Taiwan and Chang Gung University College of Medicine, Taoyuan City, Taiwan evaluated the effect of peer pressure on decision making in EPs to use CT scan for patients with dizziness/vertigo.
Dizziness is a common complaint in the emergency department (ED), accounting for 2.5% of all ED visits in the United States. While the most common causes of dizziness/vertigo are benign, a potentially serious underlying disease, such as cerebellar or brain stem stroke, may go unnoticed. Due to the uncertainty and cost of a misdiagnosis, EPs may reduce the testing threshold for brain imaging in handling these low-probability, high-morbidity situations. But unnecessary head CT examination may lead to prolonged ED stay, increased medical costs, and exposure to radiation (a potential carcinogen).
The use of CT imaging to examine patients presenting with dizziness has increased exceedingly, from 9.4% to 37.4% in the United States between 1995 and 2009. A previous study had showed that EPs vary in their respective decisions to either admit or discharge general ED patients. Senior EPs were found to have lower discharge rates compared with their junior colleagues.
The purpose of this study was, therefore, to evaluate the peer-pressure effect on the decisions of CT use for dizziness/vertigo patients by EPs with varying seniority. The EPs were categorized into 3 groups according to seniority. Group “>V12” consisted of 10 senior physicians with more than 12 years of work experience. Group “V7-V12” consisted of 9 physicians with 7 to 12 years of work experience (intermediate seniority). Group “<V7” consisted of 10 junior physicians with <7 years of work experience.
The study intervention used a behavior modifying measure by creating a “team norm” that imposed an unspoken peer pressure effect by announcing the CT-use rate of each EP by monthly e-mail reminders. Norms are the rules that the team agrees to follow and designate a standard for average performance by the whole team. Once developed, team norms are used to guide and shape team members’ behavior.
The authors explained, “To evaluate the effectiveness of peer pressure on changing EP decisions concerning CT use for dizziness/vertigo patients, we created a ‘team norm’ imposed peer-pressure effect by announcing the CT use rate of each EP through monthly e-mail reminders. We also conducted a before-and-after retrospective case review of patients who visited the ED.”
The study was conducted in a tertiary academic medical center in Southern Taiwan with over 2500 acute beds and an average of 72,000 adult ED visits per year. The medical records of nontraumatic patients who were older than 17 years of age and visited the ED with a principal diagnosis of dizziness and vertigo were extracted from the ED administrative database using the International Classifications of Diseases Tenth Revision coding system.
“Our study group consisted of 3165 patients; 1657 were enrolled in pre-intervention group while 1508 were enrolled in post-intervention group. Patients were assessed by the 29 EPs in the department,” the authors said.
The intervention strategy presented herein applied peer pressure through e-mail reminders. The findings of the study revealed a decrease in CT use for patients with isolated dizziness/vertigo, particularly among junior EPs and in younger patients. Although the study has a few limitations pertaining to the generalizability of its conclusions to other ED settings, the method used in this study offers a promising option that can effectively decrease CT use and unnecessary medical costs in ED.