Do You Believe in Magic? Shove, Don’t Nudge: Advising Patients at the Bedside


Kenneth V. Iserson


Magical thinking, distortions of reality based on fantasy, are pervasive in society and may influence patients’ healthcare decisions. These distortions can “nudge” people to make decisions using System 1 thinking (a heuristic and error-prone decisional pathway that is always “on”), rather than a slower, deliberative, and more labor-intensive process that evaluates evidence (System 2). Physicians have been castigated for subtly nudging their patients toward evidence-based decisions. Yet when patients demonstrate magical thinking in their decision making, physicians have a professional responsibility to do more than nudge; they should shove patients toward decisions that will most likely achieve the healthcare goals they seek.




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