Department of Management, University of Texas at San Antonio, San Antonio, TX, USA.
Department of Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, PA, USA.
Science. 2024 May 17;384(6697):802-808. doi: 10.1126/science.adl3835. Epub 2024 May 16.
Power-the asymmetric control of valued resources-affects most human interactions. Although power is challenging to study with real-world data, a distinctive dataset allowed us to do so within the critical context of doctor-patient relationships. Using 1.5 million quasi-random assignments in US military emergency departments, we examined how power differentials between doctor and patient (measured by using differences in military ranks) affect physician behavior. Our findings indicate that power confers nontrivial advantages: "High-power" patients (who outrank their physician) receive more resources and have better outcomes than equivalently ranked "low-power" patients. Patient promotions even increase physician effort. Furthermore, low-power patients suffer if their physician concurrently cares for a high-power patient. Doctor-patient concordance on race and sex also matters. Overall, power-driven variation in behavior can harm the most vulnerable populations in health care settings.
权力——对有价值资源的非对称控制——影响着大多数人际交往。尽管权力很难通过实际数据进行研究,但一个独特的数据集使我们能够在医生与患者关系这一关键背景下进行研究。我们使用美国军事急诊部门的 150 万个准随机分配,研究了医生和患者之间的权力差异(通过军衔差异来衡量)如何影响医生的行为。我们的研究结果表明,权力赋予了实质性的优势:“高权力”患者(军衔高于医生)比同等军衔的“低权力”患者获得更多的资源和更好的结果。患者晋升甚至会增加医生的努力。此外,如果医生同时照顾一个“高权力”患者,那么“低权力”患者就会处于不利地位。医生和患者在种族和性别上的一致性也很重要。总的来说,行为上的权力驱动差异可能会伤害到医疗环境中最脆弱的人群。