Personal view: cost and benefit of medical rituals in gastroenterology

Summary Background : Unable to resolve a medical problem, gastroenterologists occasionally choose an ineffectual intervention instead. The elusive path to effectual management becomes substituted with an ineffectual but readily available medical ritual. The term ‘ritual’ refers to the utilization of an ineffectual intervention with little chances of achieving a medically relevant goal. Aim : The aim of the article is to analyse the cost–benefit relationship of rituals in gastroenterology and the reasons why gastroenterologists utilize them. Methods : Ritualistic disease management is described in terms of medical decision and threshold analysis. Results : If the perceived benefit of a ritual exceeds its cost, the ineffectual path becomes more attractive than expectant management or doing nothing. To engage in an ineffectual intervention, the threshold probability for success needs to exceed its cost–benefit difference divided by the benefit associated with success. In choosing an ineffectual intervention, doctors tend to underestimate the true costs of a ritual and overestimate its probability of success. The availability of an effectual path leads to more stringent conditions for the benefit associated with an ineffectual path. Conclusions : A better understanding of their economical underpinnings should lead to more restricted utilization of rituals in gastroenterology, especially, in situations where they drain scarce resources disproportionately to their perceived benefit.