January 12, 2018: Behavioral Economic Principles to Understand and Change Clinician Behavior


Jeffrey A. Linder, MD, MPH, FACP
Chief, Division of General Internal Medicine and Geriatrics
Michael A. Gertz Professor of Medicine
Northwestern University Feinberg School of Medicine


Behavioral Economic Principles to Understand and Change Clinician Behavior


Pragmatic clinical trial; Behavioral economics; Antibiotic resistance; BEARI; Antibiotic stewardship

Key Points

  • As many as 30% of antibiotic prescriptions are unnecessary. Can behavioral economics explain and help guide how to change this clinician prescribing behavior?
  • Habit, pressure from patient, and a “just to be safe” mentality are the most common factors driving inappropriate antibiotic prescribing, but antibiotic stewardship is critical to improving patient outcomes.
  • The Behavioral Economics/Acute Respiratory Infection (BEARI) trial looked at three behavioral interventions to reduce inappropriate antibiotic prescribing for acute respiratory infections: suggested alternatives to antibiotics, accountable justification, and peer comparison.
  • Because doctors are people who are affected by emotion and social interaction, peer comparison had greatest effect on prescribing behavior, even after the intervention period ended.

Discussion Themes

Overall, clinicians in the BEARI trial expressed desire to follow guidelines for good antibiotic stewardship, but some of the responses in the intervention group indicated a misunderstanding of the guidelines.

Is some of the impact of interventions due to the Hawthorne effect, in that these clinicians knew they were being  enrolled in a trial, and thereby aware they are being watched and having their work reviewed?

Older doctors have been shown to inappropriately prescribe at a higher rate than younger doctors, but the question remains whether this is based on generational learning or based on decision fatigue over time.

There have been significant efforts by the Centers for Disease Control and Prevention and other public health groups to spread awareness in recent years about the antibiotic resistance and the importance of good antibiotic stewardship, so it is possible outside factors also impacted clinician behavior modification.


@PCTGrandRounds, @Collaboratory1, @NUFeinbergMed, #BehavioralEconomics, #AntibioticResistance, #AntibioticStewardship, #pctGR