The tally chart scribbled on the back of an old patient information leaflet sits on the desk in front of me, and it doesn’t make any sense. There’s a happy face on one side, a sad face on the other, and beneath each poorly drawn emoji a collection of dashes providing a pictorial representation of my morning clinic; a clinic that has left me exhausted and demoralised. There were sixteen patients in all, and I have been left with the overwhelming impression that the morning has been an unmitigated disaster.
The idea of a tally chart had come about as a result of feeling like this on a worryingly regular basis, and the concept of it is a simple one: I would allocate each consultation a positive or negative mark based on an immediate gut reaction as to whether I deemed it a success or a failure.
It isn’t the concept that is confusing me, but the results. There are fourteen dashes under the happy face, and only two under the miserable one. There are no two ways about it; it’s a landslide. It’s Germany vs Brazil in the 2014 football World Cup. It’s a North Korean General Election. It is, as the Americans would describe it, a ‘lopsided blow out’. So why then, do I feel as though I have failed?
The answer to this may have something to do with a notion known as The Negativity Bias, widely reported and referenced in the world of psychology. It is used to explain the tendency of all of us to focus more readily on negative experiences than positive ones, and to allow these negative experiences, whether they invoke terror, disappointment or anger, to influence us disproportionately.
It is, we’re told, an evolutionary mindset honed by our ancestors as a means to survival. An encounter with a hungry sabre-toothed tiger for instance may have been more memorable for our pre-historic relatives than a run-of-the-mill day spent rubbing sticks together to make fire, and this outlook would no doubt have been beneficial for their chances of survival in the long term. The next time they heard a distant roar, or a rustle in the bushes, they will have been conditioned to be more wary of the possibility of impending tiger encounters.
Doctors may be more susceptible than most to this phenomenon given the high numbers of perfectionists attracted to a career in medicine, but Negativity Bias is not a plight experienced exclusively by those in the medical profession. The consistently excellent sportsman producing one substandard performance is often branded as useless or overrated, and teachers often find themselves questioning their ability should one member of their class not achieve their expected grades.
Since first hearing about the idea of The Negativity Bias it’s become blindingly obvious that I have been demonstrating it perfectly in my professional capacity. More often than not my patients leave the room seemingly satisfied with the care they’ve received, and on most occasions will happily come back to see me again, but these are not the consultations I remember. Instead I ruminate over the irate patient, feel guilty about the unsatisfied patient, and despair at the patient that submits a complaint.
Of course it’s one thing being aware of one’s tendency to fixate on negative interactions, but quite another to change your entire perspective. But when it comes to my rudimentary tally chart, I’m feeling optimistic. Simply an awareness of negative bias may be enough to silence that voice in my head that tells me I’m useless, that that I’m failing at my responsibility as a doctor. Dashes in a positive column may provide a sense of optimism, and allow me to focus more on the patients that are happy with the care they have received.
It’s early days, but I’m hoping for a renewed self of self-worth, and not quite as many sabre-tooth tigers.
Dr Mike Forsythe