Each player must choose an action without knowing the choice of the other. Each can individually choose to hunt a stag or hunt a hare. If an individual hunts a stag, they must have the cooperation of their partner in order to succeed. An individual can get a hare by themselves, but a hare is worth less than a stag. Two equilibria can be reached:. Risk dominant — If there is uncertainty about what the other hunter will do, players are more likely to hunt hares.
Payoff dominant — If both hunters could agree in advance then the stag is preferential as it reaps the most rewards for both. Does it matter if the patient is managed by a different doctor each time they visit for their chronic disease review?
Continuity of care is an important factor for both doctor and patient in understanding how the other is predicted to behave. Repeated interactions along with the expectation of an indefinite number of future interactions may enable the establishment of trust and act to reinforce mutual cooperation, potentially leading to mutually beneficial payoff dominant outcome the stag.
Conversely, if continuity is lacking or if previous interactions have been poor for either party, this experience will lead them to adopt a more risk dominant strategy the hare.
This has implications for different aspects of primary care. From an educational standpoint, exams such as the Clinical Skills Assessment CSA or similar single encounter patient simulations do not represent routine UK general practice where the candidate will have already formed relationships good and bad with patients. The simulated patient experience is more akin to out-of hours encounters or the experience of a short-term locum GP.
I would like to stress however, this post is intended in no way to denigrate this type of work nor the simulated patient examination per se. Instead I hope to increase awareness of the fact that there are real difference between the work of GPs in different settings and that this should be recognised by both patients and doctors. These differences lead to modification of clinician behaviour in terms of strategy and risk thresholds. Does the medical record convey all the information required for doctors and patients to immediately adopt a payoff dominant strategy on first encounter?
How is the consultation different when a doctor encounters a patient outside the the traditional general practice setting e. If a doctor never expects to see a particular patient again, would you be surprised if they practised defensive medicine, had higher indemnity fees and worse outcomes?
Judgement under uncertainty: heuristics and biases. Davis MD. Game theory, a nontechnical introduction. Mineola: Dover Publications, Inc, Luce RD , Raiffa H. Games and decisions, introduction and critical survey. Poundstone W. John von Neumann, game theory, and the puzzle of the bomb. New York: Doubleday, Taylor AD. Mathematics and politics. Strategy, voting, power and proof.
New York: Springer, J Theor Biol ; : — Ivan LP. Spinal reflexes in cerebral death. Neurology ; 23 : —2. Ropper AH. Unusual spontaneous movements in brain-dead patients. Neurology ; 34 : — Spontaneous and reflex movements in brain death. Neurology ; 54 : —3. Truog RD. Is it time to abandon brain death? Hastings Cent Rep ; 27 : 29 — Bernat JL. A defense of the whole-brain concept of death.
Hastings Cent Rep ; 28 : 14 — Copyright information: Copyright by the Journal of Medical Ethics. Read the full text or download the PDF:. This works at the wider level too. We know that the pneumococcal vaccine has reduced pneumonia rates especially amongst patients in more deprived areas. Reducing smoking and ensuring vaccination are infinite game goals and they work. This is beyond the control of one person and needs a coordinated approach across healthcare policy.
The manifesto consisted of 12 points:. The problem is that finite game success is much more short-term and easier to measure than with infinite games. We can put a certain policy in place and then measure impact. Politicians who control healthcare policy and heads of department have a limited time in office and need to show benefits immediately.
The political and budgetary cycles are short. It is therefore tempting to choose to play finite games only rather than infinite. The NHS England Chief Simon Stevens laid out five priorities for the NHS focusing health spending over the next 5 years: mental health, cardiovascular disease, cancer, child services and reducing inequalities.
This comes after a succession of NHS plans since which all focused on increasing competition and choice. The Kings Fund have been ambivalent about the benefit those plans made. Since its inception the National Health Service has been an infinite game changing how we view illness and the relationship between the state and patients.
Yet if we chase finite games that are incongruous to our finite game we risk that infinite game. We all need to identify the infinite game we want to play and make sure it fits our principles and vision. Playing an infinite game means committing to values at both a personal and institutional level. It says a lot about us and where we work. It means those in power putting aside division and ego.
Above all it would mean honesty. How to be a Presentationalist. Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. Free access to newly published articles. Purchase access. Rent article Rent this article from DeepDyve.
Access to free article PDF downloads. Save your search.
0コメント