Save Face or Save Life: Physicians’ Dilemma in Using Clinical Decision Support Systems

Humans think both rationally and heuristically. So do physicians. Clinical decision support systems (CDSSs) provide advice to physicians that could save patients’ lives, but they could also make physicians feel face loss because of submission to machine intelligence, leading to a perplexing dilemma. Thinking rationally, physicians focus on fulfilling their professional duty to save patients and should follow advice from CDSS to improve care quality. Thinking heuristically, they focus on protecting their authoritative image to maintain face and are inclined to avoid embarrassment by resisting CDSS. Through a longitudinal survey and follow-up interviews with a group of Chinese physicians, we find that the dilemma does exist. Moreover, face loss has a stronger effect on CDSS resistance when physicians have high autonomy. When time pressure is high, perceived usefulness more strongly reduces, whereas face loss more strongly increases CDSS resistance, worsening the dilemma. As face is a universal social concern existing in both Eastern and Western cultures, this research generates insights regarding why physicians are slow in adopting information technology innovations.