Doctors are seen as Godlike: Moral typecasting in medicine

Highlights

• Americans view doctors as godlike and invulnerable.

• Doctors are seen as more agentic than other working professionals.

• Doctors are seen as able to ignore mental and physical health problems.

• Moral typecasting in medicine leads people to neglect doctors' suffering.

Abstract

Objective

Doctors are generally thought of as very intelligent and capable. This perception has upsides—doctors are afforded respect and esteem—but it may also have downsides, such as neglecting the mental and physical health of physicians. Two studies examine how Americans “typecast” doctors as Godlike “thinkers” who help others, rather than as vulnerable “feelers” who might themselves need help.

Method and results

Study 1 examines how a representative sample of Americans (N = 681) view the mental capacities of doctors compared to other targets (including patients, other workers, and God). Result show that people see physicians as highly capable of the thinking-related capacities of thinking, remembering, self-control, and planning (equal to that of God), but less capable of the feeling-related capacities of experiencing fear, pain, embarrassment, and hunger. Study 2 (N = 451) examines whether physician typecasting impacts other domains. People believe that, relative to the average working professional, physicians are better able to ignore physical and mental health issues, and physician job performance is less impacted by bodily and emotional limitations.

Discussion

We discuss implications for medical practice, especially the growing epidemic of physician burnout.

Introduction

By US law, medical residents are legally able to work for twenty-four consecutive hours, whereas truck drivers can work for only fourteen. Both make important decisions that can impact the lives of others, so why are doctors allowed to work so much more—especially when physician fatigue is the “Achilles’ heel of medicine” (Gaba and Howard, 2002) and physician burnout is at crisis levels (Jha et al., 2018)? Are doctors somehow seen as physically invincible and emotionally invulnerable? In this paper, we explore whether one contributor to this epidemic of physician burnout may be moral typecasting, the psychological tendency to categorize others into one of two competing roles: “thinking doers” who help others, versus “vulnerable feelers” who themselves need help (K. Gray and Wegner, 2009).

A key social-psychological framework called mind perception suggests that people see the minds of others along two broad dimensions (H. M. Gray et al., 2007): agency, the capacity for thought and action (colloquially, “thinking”), and experience, the capacity for feelings like fear or hunger (colloquially, “feeling”). Past studies on mind perception have helped to explain many facets of our lives, including how individuals make moral judgments in business organizations (Tang and Gray, 2018), how individuals react to emerging technologies like robots or artificial intelligence (Bigman et al., 2019; Bigman and Gray, 2018), and, in medicine, how individuals think about those in a persistent vegetative state (K. Gray et al., 2011).

These two dimensions of agency and experience can be perceived independently, such that it is possible to be high in both (e.g., adult humans), low in both (e.g., inanimate objects), low in agency but high in experience (e.g., infants), or high in agency but low in experience (e.g., sophisticated robots). However, some work suggests that, within morally laden contexts—including helping professions (Yam et al., 2018)—these dimensions may be inversely related, such that the more people see someone as a “thinking doer” who helps others, the less people see them as a “vulnerable feeler” who needs help. In other words, people have a tendency to morally typecast others, seeing those who help others as high in agency (thinking) but low in experience (feeling; K. Gray and Wegner, 2009). Likewise, people perceive those who receive help as having the opposite kind of mind, as high in experience but low in agency.

Moral typecasting speaks to the broader idea of how individuals categorize others into moral roles, which are some of the most important categorizations that individuals make of others (Aquino et al., 2002). Past work clearly illustrates that people divide the moral world into good and evil (e.g., Helzer; Critcher, 2018), but moral typecasting suggests that people also divide the moral world into doers of moral acts (e.g., heroes, villains) or receivers of moral acts (e.g., beneficiaries, victims; K. Gray and Wegner, 2011; K. Gray, Young and Waytz, 2012).

Typecasting people into either moral “doers” capable of thinking (but not feeling), or moral “recipients” capable of feeling (but not thinking) can have important consequences. It suggests that people might neglect the well-being of individuals they see as saint-like. Past work suggests that people see moral exemplars—such as Mother Teresa or the Dalai Lama—as less sensitive to pain than the average person (K. Gray and Wegner, 2009). This work also reveals that perceptions of mental capacities translate to decisions, as participants were more willing to mete out pain to the saintly than to average people, because they believed that the saints could better cope with it.

This work on moral typecasting may offer a new perspective on how people perceive doctors. Might people typecast physicians as high in agency but low in experience? Physicians dedicate their lives in service to others—i.e., they are moral “doers”—and they also seem to be perceived as highly capable of agency-related abilities, including thinking and self-control. If people perceive doctors as thinkers who help others, moral typecasting suggests that they may fail to see doctors as feelers who themselves need help. That is, individuals may often deny (or neglect) physicians' ability to experience emotions and bodily experiences. Consistent with this idea, past work suggests that people emphasize the knowledge and skill of doctors, but are made uncomfortable by the idea that doctors may have their own personal needs and feelings (Schroeder and Fishbach, 2015).

Typecasting therefore suggests a potential downside of the moral accolades inherent in medicine: it is nice to be seen as a force for good, but these perceptions of moral goodness could be tied to unrealistic self or other expectations about physicians' physical and mental invincibility. During medical training, physicians report a culture in which feeling sick, tired, or distressed—all signs of one's experiencing side—is seen as weakness or incompetence (McGowan et al., 2013). This has led to renewed calls for scholars to study emotional socialization in the medical training process (Underman and Hirshfield, 2016). Despite the importance of staying well-rested to maintain mental acuity, physicians work an average of 10 hours more per week than other professionals (Shanafelt et al., 2012) and experience cognitive decline, worsened mood, and impaired motor skills as a result of lack of sleep during long shifts (Comondore et al., 2008; Wali et al., 2013).

Past work helps to illustrate how inflated expectations can contribute to physician burnout (Cooper et al., 1989). For example, the greater burnout of female (versus male) physicians can be explained in part by patients' higher expectations of them. Not only do female physicians struggle to meet these high expectations in the face of other clinical and life responsibilities (Linzer and Harwood, 2018; McMurray et al., 2000), but work shows that failing to meet patient expectations can lead physicians to report less satisfaction with their jobs (Bell et al., 2002). Unrealistic expectations about physician's abilities can also lead patients to feel over-optimistic about their own treatment outcomes even after their physicians have informed them of the risks, likelihood of success, or descriptions of alternatives to treatment (Horng et al., 2002; Weinfurt, 2004). For all these reasons, “typecasting” physicians as high in agency but low in experience may help explain the current epidemic of physician burnout (Jha et al., 2018).

In this paper, we investigate the moral typecasting of physicians and medical professionals. In Study 1, we use a representative sample of Americans to examine how people view the mental capacities of doctors, nurses, patients, and other non-medical workers. We hypothesize that participants will perceive medical professionals as “thinkers”—highly capable of thought and action (agency)—but not “feelers”—relatively incapable of feeling pain or hunger (experience). In Study 2, we examine the implications of this medical moral typecasting, testing whether people think that doctors are better able to ignore mental and physical health problems in their job and to exert exceptional self-control in their everyday lives. Because past research shows that public perceptions can influence public policy on health-related topics (Barry et al., 2009; Gendall et al., 2015), it is possible that super-humanized, typecast perceptions of physicians may contribute to policies that engender engender physician burnout, such as unrealistic mandates about work hours or patient loads. If people see doctors as invulnerable thinkers—unaffected by pain, tiredness, or stress—there is no need to consider policies that protect their health or well-being, whether for their own sake or those of the patients they seek to help.

In Study 1, we examine how a representative sample of Americans typecast doctors, patients, and other workers as agentic thinkers versus experiencing feelers. We predict that participants will typecast doctors as possessing high agency but relatively low experience.