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Game theory
The consultation game
  1. G Elwyn
  1. Correspondence to:
 Professor G Elwyn
 Primary Care Group, University of Wales Swansea, Swansea SA2 8PP, UK;

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Exploring the use of game theory to address quality

Game theory and clinical practice seem an unlikely marriage and it may not be obvious how such a combination could improve the quality of clinical consultations. But this area of applied mathematics seems set to reduce some of our quintessential human foibles to a predictable set of behaviours based on what you win and what you lose (forget about how you play the game—at last it’s officially all about winning). Game theory could be a sharp new tool for dissecting the mass of behaviours at play in the medical consultation, a historically paternalistic human interaction that stretches back as far as Hippocrates.

Medicine is a service delivered by a mix of episodic and repeated interactions between humans, medicated by the use of technologies such as tests, drugs and procedures. There is clear evidence that there is communication failure in consultations and that adherence to advice and treatment is 40–50% less than optimum, yet explanations and successful interventions to address this problem are rare. It is also clear from many empirical studies that the quality of the consultations and communication processes is far from optimum when examined from patient perspectives, and results in inefficiencies, errors and costs, not least the medicolegal expense of patient claims.


The central principle in game theory is that “players think about what others are likely to do, and do so with some degree of thought”.1 Although there are many types of games used to explore this “thinking”, all have a structure …

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