TY - JOUR T1 - Harnessing choice architecture to improve medical care JF - BMJ Quality & Safety JO - BMJ Qual Saf SP - 353 LP - 355 DO - 10.1136/bmjqs-2020-012598 VL - 30 IS - 5 AU - Donald A Redelmeier AU - Mian-Mian Kao Y1 - 2021/05/01 UR - http://qualitysafety.bmj.com/content/30/5/353.abstract N2 - People live busy complex lives where most decisions need to be made quickly. As a consequence, people tend to prefer simple rather than expanded choice sets, easy alternatives that require no complex tradeoffs and benign options that avoid major moral quandaries. Choice architecture is defined formally as the behavioural science examining how the layout, sequencing and range of available options can influence decisions. The Google search engine, for example, is a familiar illustration of refined choice architecture where its spartan user interface tries to avoid overloading individuals, provoking deep thought or maximising information. The core assumption is that people want to feel gently guided and not overwhelmed. The intriguing insight is that many unrecognised features of choice architecture can influence decisions.In this issue of the journal, Hart et al explore physicians’ knowledge of choice architecture in medical care.1 The investigators focus on eight principles related to decision science including how first impressions are weighted heavily, defaults matter, people are risk averse toward gains, multiple options increase status quo bias and social norms have abounding influence. The main finding is that over one-third of basic questions on these principles were answered incorrectly by medical residents. An important added finding is that the majority of medical residents endorsed the relevance of choice architecture for clinical practice. Together, this careful and thorough study identifies a shortfall in physicians’ understanding of decision science and an … ER -