A Doctor Will See You Now: Physician-Patient Relationships and Clinical Decisions

The physician-patient relationship is central to the practice of health care, yet little is known about how it affects physician decisions. We compare obstetricians’ (OBs’) treatment decisions for patients with whom they have a pre-existing clinical relationship (their “own patients”) and patients with whom they had no prior relationship (“others’ patients”) in a setting where the delivering OB is as good as randomly assigned. When OBs deliver their own patients they are 25% (4 percentage points) more likely to perform a C-section, a differential that increases in the OB’s prior interaction with the patient. We also find that OBs’ treatment choices are consistent with OBs receiving greater disutility from their own patients’ difficult labors. After a string of difficult labors, OBs are more likely to perform C- sections on their own patients and this pathway can explain the entire overall effect. These treatment differences do not appear to have measurable effects on infants, but mothers delivered by their own OB avoid some short-run complications of labor. (JEL I11, J16, J44)