‘Choice overload’ may not apply to physicians, new study suggests

A new study indicates that how electronic health record (EHR) systems present treatment options may have a meaningful impact on clinical decision-making. Researchers from Northwestern University and the University of Sydney report that primary care physicians (PCPs) were more likely to choose evidence-based alternatives when EHR prompts offered two or more appropriate options instead of a single choice.

Published Thursday, Nov. 13, in JAMA Network Open, the trial involved 402 U.S. PCPs responding to common clinical scenarios. Physicians who were offered multiple options selected an alternative treatment 62% of the time, compared with 44% among those offered only one suitable option.

Adding more than two alternatives did not improve decision-making further.

“We’re trying to make it easier for physicians to do the right thing,” said Jeffrey Linder, M.D., M.P.H., chief of general internal medicine at Northwestern University Feinberg School of Medicine.

Lead author Gemma Altinger, an applied behavioral economist and Ph.D. candidate at the Faculty of Medicine and Health, University of Sydney, said health systems should consider how EHR alert design shapes real-world patterns.

“Doctors are getting more and more alerts during patient consultations, but if they are based on outdated evidence, the systems designed to improve care could end up doing more harm than good,” Altinger said.

A closer look

Physicians worked through two scenarios frequently encountered in primary care:

• Hip osteoarthritis management: Choosing whether to continue with a surgery referral or consider a different NSAID.
• Low-back pain management: Deciding whether to refill an opioid prescription or select an NSAID after an alert suggested reconsidering the opioid.

Participants in the control group saw one appropriate NSAID alternative.

Those in the intervention arm saw two, three or four evidence-based options matched for risk-benefit profiles.

Across both scenarios, physicians with multiple choices were more likely to select an alternative to the status-quo plan. The effect was far stronger in the opioid-refill scenario, where shifting away from an opioid was nearly twice as likely with multiple appropriate NSAIDs presented.

Challenging assumptions about “choice overload”

The findings counter a well-known 1995 study suggesting that adding more alternatives can push physicians toward the default option — a concept often cited as “status-quo bias.”

This trial found no such pattern. Instead, physicians appeared more open to selecting a suitable alternative when more than one reasonable option was available.

The authors suggest that a small, carefully constructed set of choices can nudge clinicians toward higher-value care without creating unnecessary complexity or alert fatigue.

For now, the trial suggests that a modest set of relevant alternatives — rather than a single prompt or a cluttered alert — could help physicians more consistently choose high-quality care.