In a perfect world, it would be easy to flock to the doctors who produce the best health outcomes. There would be no need to theorize about the meaning of medical credentials on ZocDoc profiles. (Is a clinical internship in the former Yugoslavia a good or bad sign?)
In a recent study, Jason Fletcher of the University of Wisconsin attempted to create a value added metric for doctors who handled hospitalizations. He found that having a doctor in the 75th rather than 25th percentile could mean a 10 percent decrease in costs and a five percent reduction in the length of a hospital stay.
Unfortunately, while technology now allows us to know the Myers-Briggs score of every single person in a 25-mile radius, we still can’t easily determine which doctor is most likely to improve our health. There’s not much information out there when you’re choosing, and for people currently receiving treatment it’s impossible to know how their health would be different if they had chosen somebody else.
People chose physicians whose focus matched their desired ideal emotional state, but not how they felt in the moment.
If people can’t choose a doctor based on performance, how do they choose? For those of us who live in towns or cities with more than one doctor, social networks are still important. But what about when people can’t get a recommendation? Or when they get conflicting recommendations? And what makes people decide to stay with a doctor after an initial visit?
Research led by Stanford psychologist Tamara Sims suggests that one answer is the emotional fit between patient and doctor. Sims’ research specifically focuses on two types of emotional states—“High arousal positive states” (HAP), such as passion and excitement, and low arousal positive states” (LAP), such as relaxation and calmness—and whether or not a patient’s desired state matches a doctor’s focus.
In an initial study published last year in the journal Emotion, Sims and her colleagues asked participants to imagine that they had to choose one of three potential physicians based on a short description. One description was of a HAP-focused physician who enhanced patient well-being by increasing activity and vitality. A second description was of a LAP-focus physician who enhanced patient well-being by promoting a calm and relaxed lifestyle. A third physician, who served as a control, was described as being focused on administering medical care. After choosing one of the three physicians, participants completed a series of items that measured the degree to which their actual affect—how they typically feel—and their ideal affect—how they would like to feel—aligned with HAP or LAP.
Sims found that ideal affect predicted which physicians participants chose. Participants who ideally wanted to feel LAP (relaxation, calmness) were more likely to choose LAP-focused physicians, while participants who ideally wanted to feel HAP (excitement, vitality) were more likely to choose HAP-focused physicians. Importantly, participants’ current affective state had no relationship with physician choice. People chose physicians whose focus matched their desired ideal emotional state, but not how they felt in the moment.
These results provided initial evidence of the importance of emotional fit between patients and doctors, but does that fit actually influence how patients behave outside of the lab? A new follow-up study led by Sims suggests that the answer is yes.
Sims and her colleague Jeanne Tsai recruited 101 adults from around the San Francisco Bay Area to participate in a study that was ostensibly a test of a virtual health center. Using the “Virtual Bay Health Center” website, participants filled out forms about their health and affect. Afterwards they watched an introductory video featuring their assigned physician. The physicians emphasized either activity and vitality (HAP) or relaxation and calmness (LAP). Two days later all participants received the same feedback—that they were in “good” health—and the same list of six health recommendations (e.g. take a brisk walk after dinner.) For the next five days participants reported on whether or not they engaged in the behaviors recommended by their virtual physicians, as well as their actual and ideal daily affect. At the end of the five days participants evaluated their physician on trust, knowledge, and competence.
Once again, Sims found that the match between a patient's ideal affect and their physician's affective focus was important. First, the more participants wanted to feel LAP, the more positively they evaluated LAP-focused physicians, and the more they wanted to feel HAP, the more positively they evaluated HAP-focused physicians. Second, and more importantly, these evaluations seemed to influence actual behavior. Participants who ideally wanted to feel LAP were more likely to follow the recommendations of LAP-focused physicians, and participants who ideally wanted to feel HAP were more likely to follow the recommendations of HAP-focused physicians. Taken together, the two studies show that the match between a patient's ideal affect and a doctor’s affective focus can influence doctor selection, doctor evaluation, and adherence to doctor recommendations.
Given that patients still don’t have much information about doctor effectiveness, using ideal affect as a guide is actually a decent way to choose a doctor. At the very least, you’re choosing a doctor whose recommendations you’re likely to follow. And even if those recommendations aren’t perfect for your physical health, the emotional fit is likely to produce better emotional health. The perception of good “bedside manner” is not a trivial thing.
Emotional fit also compares favorably to other ways of evaluating doctors. Research suggests that patients prompted to see a doctor by pharmaceutical advertising will become unsatisfied with doctors who fail to prescribe the medication in the ad, for example. Here, patients evaluate doctors based on whether or not the doctor is willing to give them what they want, even if it were to produce a bad medical outcome.
If we ever manage to create a utopia overflowing with information about doctor performance, patient desire for an emotional fit with their doctor could become a problem. At that point people may choose inferior doctors simply because a doctor’s HAP or LAP focus matches how they would like to feel. But for now, it would appear that our emotion-based intuitions about choosing a doctor put us on the right track.