Behavioral Architecture in Health Care

Behavioral architecture applications in health care are numerous. Everything from default settings on ventilators, to drug formularies, to where instructions are placed on sterile surgical supply packages, for example, can motivate efficiency, encourage benefit maximization, curb risk, and contain costs. But many of these nudges’ influences on patients’ or clinicians’ decisions are not transparent, so health care organizations’ adoption of behavioral architectural strategies is rarely ethically neutral.

Volume 22, Number 9: E751-829 Full Issue PDF
  • From the Editor in Chief
    Sep 2020

    Health of We the People

    Audiey C. Kao, MD, PhD
    Consensus about clinicians’ roles in civic engagement is lacking, but there is no denying that public policy and participation in democracy affects the health and well-being of patients and communities.
    AMA J Ethics. 2020;22(9):E753-756. doi: 10.1001/amajethics.2020.753.
  • From the Editor
    Sep 2020

    Behavioral Psychology in Medicine: The Good, the Bad, and the Unknown

    Anum Fasih, MD
    Behavioral psychology considers connections between our thinking and reasoning tendencies and how we respond to environmental stimuli. Behavioral architecture applies what we know about those responses to influence our actions.
    AMA J Ethics. 2020;22(9):E757-759. doi: 10.1001/amajethics.2020.757.
  • Medical Education
    Sep 2020

    Believing in Overcoming Cognitive Biases

    Tiffany S. Doherty, PhD and Aaron E. Carroll, MD, MS
    Like all humans, health professionals are subject to cognitive biases that can render diagnoses and treatment decisions vulnerable to error.
    AMA J Ethics. 2020;22(9):E773-778. doi: 10.1001/amajethics.2020.773.
  • Policy Forum
    Sep 2020

    Sharing Ethics Consultation Notes With Patients Through Online Portals

    Dominic R. Mangino, MS and Marion Danis, MD
    Patients can now easily view their health records, so clinicians must consider a reader’s interpretation of how they convey sensitive personal health information. What might this mean for ethics consultants?
    AMA J Ethics. 2020;22(9):E784-791. doi: 10.1001/amajethics.2020.784.
  • Policy Forum
    Sep 2020

    Ethical Choice Architecture in Preabortion Counseling

    Carol A. Westbrook, MD, PhD
    Most women requesting pregnancy termination have already decided to undergo an abortion, but some jurisdictions have implemented strategies to induce doubt and regret.
    AMA J Ethics. 2020;22(9):E792-795. doi: 10.1001/amajethics.2020.792.
  • Medicine and Society
    Sep 2020

    Designing Nudges for Success in Health Care

    Joseph D. Harrison, MBDS and Mitesh S. Patel, MD, MBA
    Nudges can improve patient outcomes, but decisions need to be made about where they fit in the flow of health service delivery.
    AMA J Ethics. 2020;22(9):E796-801. doi: 10.1001/amajethics.2020.796.
  • Medicine and Society
    Sep 2020

    How to Keep Diffusion of Responsibility From Undermining Value-Based Care

    Leah M. Marcotte, MD, Jeffrey Krimmel-Morrison, MD, and Joshua M. Liao, MD, MSc
    Individuals can underperform in circumstances of shared accountability. In clinical settings, this is an unintended consequence of the health care sector’s complexity fragmentation.
    AMA J Ethics. 2020;22(9):E802-807. doi: 10.1001/amajethics.2020.802.
  • Art of Medicine
    Sep 2020

    High Stakes, Serious Noticing

    Aldis H. Petriceks
    Behind the immediate pathophysiology of a medical condition often lies the emotional turmoil of an uncertain patient.
    AMA J Ethics. 2020;22(9):E808-811. doi: 10.1001/amajethics.2020.808.
  • Art of Medicine
    Sep 2020

    Arches of St John’s

    Richard Wu
    This photograph depicts a gateway at the Oud Sint-Janshospitaal, a medieval Flemish hospital.
    AMA J Ethics. 2020;22(9):E812-813. doi: 10.1001/amajethics.2020.812.
  • Art of Medicine
    Sep 2020

    Ageism as a Species of Bias

    Elisabeth Miller, MD
    Good health care for elders requires acute ethical attention to the role of ageism as a pervasive source of bias.
    AMA J Ethics. 2020;22(9):E814-815. doi: 10.1001/amajethics.2020.814.
  • Art of Medicine
    Sep 2020

    Choosing Unwisely

    Abey Kozhimannil Thomas, MD
    This comic conveys the absurdity of overreliance on symptom measures and excessive testing in contemporary clinical decision making and health care practice.
    AMA J Ethics. 2020;22(9):E816-817. doi: 10.1001/amajethics.2020.816.
  • Art of Medicine
    Sep 2020

    Data, Decisions, White Coats

    Christine Lynn Chen
    This pen and ink drawing reimagines a white coat in the context of medicine’s realistic, not idealized, dynamism.
    AMA J Ethics. 2020;22(9):E818-820. doi: 10.1001/amajethics.2020.818.