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People can anticipate which option will cause more regret should the outcome be poor. Therefore people are reluctant to choose these options, despite the additional QALYs they may engender. For example, physicians may harbor misgivings about the aggressive care surrogate decision makers may advocate for a particular patient, but the surrogate may be acting so as to minimize regret: “I’d feel horrible if I didn’t give her every possible chance to survive.” Heckerling, Tape, and Wigton (1992) found that anticipated regret also influences the decision making of physicians, although these authors and others have also used the term “chagrin” rather than “regret.” Physicians who would experience greater regret over failing to diagnose a case of pneumonia than over ordering unnecessary x-rays estimated lower probabilities of pneumonia for those patients for whom they ordered x-rays. In other words, physicians who would regret false negatives more than false positives ordered x-rays even for persons who had a low probability of pneumonia. This is a way of minimizing the occurrence of the event that would cause the most regret, namely, the false negative. The physicians, patients, and surrogate decision makers would undoubtedly assert that they are acting in the patient’s best interests—cost-benefit analyses and QALYs notwithstanding.
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