The Complex Effects of Physician Power and Patient Competence on Medical Compassion

Abstract

Compassion is central to medicine, a profession dedicated to alleviating the suffering of others. Despite its centrality, little is understood regarding the factors that may influence care. Of interest to the current thesis are possible power differentials within the patient-physician relationship. While basic sciences research indicates that power tends to reduce care, there are no empirical studies investigating power’s effects on compassion in health. The current study experimentally investigated the effects of physician power and patient competence (a proxy for patient power) on medical compassion and, additionally, tested for possible trait moderation of the effects of power on care. Eighty-two medical trainees aged between 18-39 were recruited from the University of Auckland and the University of Otago. All participants completed a 40-minute Qualtrics survey comprised of demographic questions, patient compassion ratings (assessing participants’ degree of liking, care, and desire to help each patient), and six dispositional measures. Participants were randomised into either a high or low physician power condition and presented with a corresponding physician narrative (manipulated to reflect high vs. low physician power). Participants then read two counterbalanced patient vignettes (manipulated to reflect levels of patient power; high vs. low patient competence) and provided compassion ratings for these two patients. In contrast to expectations, while the power manipulations were successful, mixed model ANOVAs showed that physician power did not predict compassion. Patient competence unexpectedly predicted compassion whereby lower competence predicted greater care; there was, however, no interaction between these factors. As for possible moderators, trait empathy and dispositional sense of power both predicted greater medical compassion though neither moderated the link between experimental variables and outcome. These results are inconsistent with prior studies finding that power reduced care, although they cohere with a smaller body of literature suggesting that power increases care when associated with responsibility. Findings are interpreted in terms of the unique context of healthcare, the likely role of social responsibility in understanding the effects of power in medicine, and the possibility that power can lead to greater (subjective) competence. Limitations and future directions for the study of key factors in the patient-physician relationship are given.