Among television’s many bad psychiatrists and psychologists — Frasier Crane of “Frasier,” Jennifer Melfi of “The Sopranos” — Dr. Hannibal Lecter is probably the worst. As depicted in the recently-canceled NBC show “Hannibal,” not only is Lecter a cannibal bent on murder and mayhem, but an emotionally empty vessel — a cold fish lacking in empathy. When presented with a patient, he sees not a person desperately in need of care, but an ingredient for a gourmet meal.
As horrible as Lecter’s attitude is, however — and as curt as some doctors seem in an age of rushed consultations that take a toll on health-care quality — it takes two to tango. In a new paper published in the journal Social Psychological and Personality Science, researchers found that patients sometimes perceive their doctors as mere robots — a perception that may change the quality of the care they receive.
“Patients believe physicians are like empty vessels,” Juliana Schroeder, an assistant professor of management at the University of California at Berkeley, and Ayelet Fishbach, a professor of behavioral science and marketing at the University of Chicago, wrote. “… We provide evidence that when in greater need of health care, individuals perceive physicians as lacking personal attributes and not having personal lives but want physicians who have patient focused attributes.”
For the paper — “The ‘Empty Vessel’ Physician: Physicians Instrumentality Makes Them Seem Personally Empty” — Schroeder and Fishbach completed six different experiments that measured how important participants perceived doctors in their lives. What they found was surprising, Schroeder said — the more a person thought they needed a doctor, the less they knew about that doctor’s personal life.
“You might expect that the more someone needs their physician, the more they attend to every single aspect of their lives,” Schroder said in a telephone interview with The Washington Post. “They should care more about them when they need them.”
In one survey of 99 patients, Schroeder and Fishbach determined patients knew fewer facts about, for example, the marital status or hobbies of their doctors than the number of similar facts they thought their doctors knew about them. And, unexpectedly, the greater a doctor’s “instrumentality” — that is, importance — to a patient’s care, the fewer facts a patient knew about that doctor.
“Patients seem to overlook physicians’ personal experiences, yet believe physicians are attentive to the personal details of their patients’ lives,” the paper read.
Another survey of 70 patients — memorably called “Surprised by Dentists’ Experiential Activities” — measured how surprised patients would be to see their dentist at “a fancy-five star restaurant” or “the city’s best museum.” In the paper’s logic, such “experiental activities” would show a dentist’s rich personal life as opposed to, say, seeing one’s dentist at a Laundromat or grocery store.
“Participants who felt like they needed their dentists more reported that they would be more surprised to see them engaging in experiential activities and not just at low-status locations,” the paper read.
And, as the researchers found by comparing 70 patients in the waiting room of a university medical center with 80 non-patients in a dining hall, those worried about their teeth were more likely to think physicians’ emotional focus is on them.
“Clinic patients, who have greater need for health care, perceive physicians to have less self-focused emotion compared to non-patients who have less need,” Schroeder and Fishbach wrote.
In some ways, this isn’t shocking. Of course: People who think they are sick want more attention than people who think they are healthy, and expect their doctors to give them that attention. Isn’t that what doctors get paid so much for?
No one is immune to feeling slighted — even an MD. “Patients’ perceptions may also affect physicians,” Schroeder and Fishbach wrote. “… Negative consequences may result when patients overlook physicians’ personal characteristics (e.g., self-focused emotions) the patient does not need.” Such patient attitudes can “make people feel objectified” and “contribute to physician burnout.” Forty-six percent of physicians in a recent survey, the researchers noted, “report experiencing at least one symptom of burnout.”
“Feeling objectified might lead to dislike for the patient, which might lead to worse care for the patient, who did the quasi-objectifying in the first place, because he had a problem and saw the doctor as the solution,” Julie Beck wrote in a piece about the study at the Atlantic.
Almost six years after the passage of the Affordable Health Care Act, legislators are still debating how to make doctors more responsive to patients. But, it seems, some of that burden may be on patients.
“This suggests — ironically — that patients’ own perceptions of their physicians as empty vessels could, at least partly, ultimately reduce their quality of care,” Schroeder and Fishbach wrote. “Practitioners and policy makers considering how to improve health care quality may therefore want to target patients’ attitudes toward their physicians, not just physicians’ attitudes toward patients.”
And, of course, “empty vessels” aren’t just in exam rooms. Schroeder pointed out a similar dynamic may play out in “exchange relationships” such as those between employers and employees. Bosses like to be asked how their days are going, too.
“People appreciate it when you notice personal aspects of their lives,” she said. “It’s less of an exchange relationship, more of a personal relationship.”