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Do HCPs really have low empathy towards patients? Here's a behavioral science answer.

Behavioral science explains why HCPs often blame patients for their own suffering because of Actor-Observer Bias.
ImageNewristics Image6 January 2020

Actor-Observer Bias is to blame for your quick negative judgments

Actor-Observer Bias occurs when a person attributes another person’s behavior to their personality but justifies their own behavior as a result of situational factors. This phenomenon penetrates many aspects of our day-to-day life.


For example, a physician might consider an overweight patient as lazy and unmotivated but will attribute his own obesity to the long hours and intensity of his job. This bias tends to diminish with friends and family because we know more about their history, motivations, personality, and circumstances.

Actor-Observer Bias influences decision-making because it shapes how individuals perceive and ultimately characterize others, often making quick negative judgments about others’ personalities, while excusing their own behaviors as arising due to external or situational factors.

Actor-Observer Bias is usually at play when judging or evaluating others’ behavior, or reflecting on one's own. The bias is tied to the psychological concept of Locus of Control, which is essentially the degree to which people believe different events in their lives are determined by external forces as opposed to having personal control over events’ outcomes.

When we make situational excuses for our actions, we are attributing an external Locus of Control to our lives, thus diminishing personal responsibility. This is likely a form of ego-preservation, which helps us maintain a positive self-image.

Actor-Observer Bias and donating to the homeless
In the US, on any given night, over 600,000 people are homeless. When you look at the number of people who have been homeless at some point in their lives, this number skyrockets to 1,300,000.


While it is true that a lot of people will give money to help the homeless, if you were to ask people who donate, how they choose the cause to support they might say: “I want my money to reach the needy and not support the middle man”.

So why wouldn’t they just directly give their money to someone in need? The most effective way to get people out of poverty, based on numerous studies, is to give people cash as opposed to supportive services. So why don’t people do this more in the US?

People often, wrongly, make excuses about the less fortunate such as: “They will just waste the money,” “They may not really be homeless,” and “But look they have a car”. Most reasons not to give cash donations are completely unfounded. Rarely is anyone trying to cheat the system! The vast majority are truly needy and would benefit from cash donations which they could use to invest and better their lives.

For the observer, Actor-Observer Bias tells them that the homeless aren’t motivated or they aren’t willing to work hard. This means the observer wrongly places blame on the homeless person. It can be hard to relate to the more likely narrative – that other factors are to blame – because we think we would work harder to ensure that we never would end up in this situation.

Fighting Actor-Observer to change the way we look at homelessness

Often homeless individuals hold signs asking for donations on the street. What if you flipped the lens? Perhaps you could change the sign to messaging that puts the ‘observer’ in the shoes of the ‘actor’. Some examples are: “What if you hadn’t eaten in 3 days?” or “I served in Iraq to help you. Now I am homeless.” This type of education and awareness can help people understand the effects of this bias and work to overcome it.

A great example of flipping the lens is from 2019. who had just lost his job, stood by the side of the road in 110-degree weather in Arizona with a sign that read: “Please take a resume. Looking for a job. Just laid-off.” The result: Mr. Hoagland's sign went viral and he received 100s of job offers!

Actor-Observer Bias in medicine

Actor-Observer Bias can influence how physicians approach and treat patients. In many disease states, the physician may incorrectly judge the patient due to Actor-Observer Bias. They may even go to the extreme of silently blaming the patient for the situation, not the condition. Almost every metabolic, (remove many) psychiatric, and respiratory condition would qualify for this kind of influence leading to differences in:

  • How physicians approach treatments
  • Which patients do they want to treat and invest time in
  • Which patients do they judge as a waste of time

Let’s look at chronic pain. There are 3 major ways Actor-Observer Bias comes into the chronic pain category:

  1. Between 2 chronic pain patients, one would think that if you have pain and I have pain, we can relate and bond. But that’s not the case with pain. MY pain is special and reflects hardships. Your pain is different and you are always complaining.
  2. Between patients and caregivers, early on the caregiver can understand and empathize. But as the pain worsens, and you need them the most, the opposite happens. The worse you get, the less empathetic they become. They may even get to the point of resentment.
  3. Between the patient and physician, it has been documented in medical literature, that physicians cannot appreciate patients' pain. For African American patients, in particular, physicians undertreat pain. They don’t believe the patient is in as much pain as they say they are.

The same disease state manifests itself in many different ways and directly affects the treatment options.

Fighting Actor-Observer Bias in medicine

Start by looking for evidence of physicians judging or blaming patients. Keep in mind that there will be little segmentation in the market based on how much or how little physicians blame patients. This bias is very difficult to fight through messaging! Actor-Observer Bias is one of the hardest biases to fight. Please proceed with caution because physicians or patients could become defensive. It is a very fine line that must be walked to avoid alienating your customer base.