The Built Environment for Professionalism.

The social contract between the public and health professions is fraying, challenged by changes in the organization and financing of health care, and by a collective failure to meet some of the expectations of society. It is timely for family medicine to acknowledge the social contract, to accept responsibility for its the role in renegotiating this contract, and to partner with other practice communities in doing so. Human behavior is strongly directed by our environment and risk aversion rather than rational decision making and it is possible to design our practice environment to “nudge” clinician behaviors purposefully toward professionalism. Current leveraging of professionalism is a path to burnout and the alternative is to create a built environment for good care that also supports professionalism rather than taking advantage of it. There are good examples to draw on, and further experimentation, partnerships, policy, and facilitation of practice redesign are needed to get there.