ABSTRACT As primary care practitioners are the health professionals closest to patients’ everyday lives, they are most likely to experience the impact of policies that support the patient choice agenda. The government’s approach to increasing patient choice has been subject to criticism by those sceptical of its politics and by those concerned with its influence on health providers and some patient groups. A perspective missing from the debate is one informed by research on the psychology of choice. Some psychologists have argued that a seemingly inbuilt preference for choice can adversely affect the decision-making process and that presenting healthcare decisions as choices may result in less reasoned decision making. It is important that GPs encourage patients to make reasoned healthcare decisions that are informed by an evaluation of the options rather than by a simple preference for choice. Patients are likely to be less satisfied with, and experience more regret about, choices made without reasoning. Keywords choice behavior; decision making; patient choice. referrals will mean that patients will have ‘dozens more hospitals and clinics to choose from’. 5 GPs are now expected to help patients choose where they attend for a specialist appointment or further treatment, and this role looks set to expand. 6 A number of commentators sceptical of the politics of the choice agenda have voiced their concerns about its impact on the healthcare system. 7,8 Those concerned with inequality of access to services have argued that the offer of increased choice will benefit the vocal middle classes at the expense of more vulnerable groups. 9 Missing from existing critiques of the ‘choice in health’ agenda has been the perspective of psychologists researching in the area of decision making. From this work comes evidence that increasing people’s options has the potential to affect adversely how they make decisions. 10 Framing decisions as ‘choices’ may increase the attractiveness of the options on offer and decrease the likelihood that a systematic evaluation of the advantages and disadvantages of each option is carried out. THE ‘LURE OF CHOICE’ Why is choice so attractive? Animals and humans seem to have an inbuilt preference for a choice-rich environment that may have evolved because choice can provide advantages in the natural environment. 11,12 For example, in many species, female animals are more likely to select a mate where competing males congregate with their competitors. 13 There are a number of reasons why a preference for choice may be advantageous in evolutionary terms. First, it is a way to defer commitment to one option for as long as possible and to continue gaining information about alternatives. Second, having a choice of mate (or habitat or food source) may increase the likelihood of selecting a higher quality option. Therefore, humans may have evolved a decision- making heuristic, or rule of thumb, that ‘choice is better than no choice’. Heuristics are cognitive shortcuts that reduce thinking effort so that everyday decisions can be made more efficiently. 14 By reducing cognitive and emotional involvement, heuristics can also help to reduce the experience of conflict often associated with making difficult decisions. 15 However, decisions made using heuristics are based on judgements about subsets of the decision information (for example, who is offering the decision information) rather than a systematic evaluation of LD Bryant, PhD, lecturer in the psychology of healthcare; HL Bekker, PhD, chartered health psychologist, senior lecturer in behavioural sciences; A House, MRCPsych, DM, professor of liaison psychiatry, Leeds Institute of Health Sciences; N Bown, PhD, senior lecturer in organisational psychology, Leeds University Business School, University of Leeds, Leeds. Address for correspondence Dr Louise Bryant, Leeds Institute of Health Sciences, Charles Thackrah Building, 101 Clarendon Road, Woodhouse, Leeds, LS2 9LJ. E-mail: l.d.bryant@leeds.ac.uk Submitted: 14 December 2006; Editor’s response: 15 February 2007; final acceptance: 16 May 2007. ©British Journal of General Practice 2007; 57: 822–826. British Journal of General Practice, October 2007 LD Bryant, N Bown, HL Bekker, et al 822 The lure of ‘patient choice’ Louise D Bryant, Nicola Bown, Hilary L Bekker and Allan House INTRODUCTION Choice is everywhere in the NHS: the word that is. In the White Paper ‘Our health, our care, our say’ 1 ‘choice’ is used no less than 95 times. Increasingly, ‘choice’ appears as a mantra in government policy and ministers’ speeches: patient choice, it is argued, is what the modern health services’ consumer demands and has a right to expect. 2,3 As the health professionals who are closest to patients’ everyday lives, primary care practitioners are most likely to experience the impact of patient choice policies. 4 The launch of the Extended Choice Network for GP