Pity Bias

We love underdogs.  Rocky made Sylvester Stallone millions with one great storyline: little guy beats giant.

We hate fat cats.  Our favourite villains have always been rich and powerful.

Regardless of fact, some stories of oppression sound truthier than others.  We want to believe them just in case they’re true. Pity bias moves us.

At the same time, stories of the rich and famous ruining their lives remain popular news.  We love hearing about it.  Part of us enjoys their pain, schadenfreude perhaps.  While we naturally feel pity for underdogs, we just as easily feel no compassion for rich people in rehab.

Public Perception

Except for when doctors get kidnapped in Pakistan, physicians do not engender pity.  Sick patients want to believe in perfect providers.  Historically, physicians played this role as expected of them.

Despite modern redefinitions of le bon docteur, physicians are still labelled the ‘most responsible’ provider.  Lawyers go after doctors, not healthcare teams.

What’s more, physicians work hard.  Driven, from grade school though decades of training, if they survive, doctors’ work ethic turns into above average incomes.

Too Powerful

Stories of physician hegemony always resonate with the public and all levels of system leadership.  Regardless of fact, people believe physicians run healthcare with bureaucrats trying in vain to manage them.  Other providers guarantee a sympathetic audience by telling stories about oppressive doctors.

In large hospitals, departments can have 200 nurses, with dozens of clerks and support staff backed by big, rich unions.  Often 4-6 full time, non-physician managers get hired to lead.  The same department typically hires 1 part-time physician to help with system decisions.  Big, progressive hospitals might devote 40 hours of support divided between a couple physician leaders for large departments, but it’s rare.

Despite being out-numbered by more than 5:1 in funded leadership hours, the ‘doctors have too much power‘ complaint always gains a sympathetic hearing.

Rhetoric of Oppression

Appeal to oppression moves audiences. We love underdogs. It biases decisions before discussion begins.

We need facts.  Transparency.  In a public system, taxpayers should know who holds the reins.  We should post lists of all leadership positions in Medicare including training/degrees held.  Compared with bureaucrats and other providers, only a sprinkling of the 25,000 practicing physicians in Ontario holds leadership spots.  Medicare needs more physicians in leadership; a stronger voice, not less influence.  Doctors bring unique value others cannot deliver.

Compassion, Not Pity or Bias

Physicians do not need or deserve pity.  Most don’t want it.

At the same time, we need to be alert to the pity reflex no matter who’s telling the story.  Of course we need compassion for all complaints regardless of who raises them.  But pity should not bias operations.

Let’s be careful that our love of underdogs doesn’t bias decisions about patient care.