Power vs. Compassion
- Hannah Todd
- Apr 17, 2022
- 4 min read
This past weekend, I had a wonderful time catching up with someone that I haven’t seen in a long time. We are in different career fields, but there is some overlap in that we both work with people who are going through difficult times. As we swapped stories and observations, the clearest similarity emerged – we both feel that the systems we navigate for our clients are structured in ways that are actively detrimental to our clients. We discussed ways that we each had daydreamed better solutions for our respective fields, and nothing we proposed seemed out of reach. Rather, it seemed like the people at the top, the decision makers, were simply not thinking of the people whom their decisions might actually be impacting…our clients. I’ve been thinking about this all week, and wondering how major systems in our country, like health care or the judicial system, are designed in such a seemingly obtuse way rather than thoughtfully keeping the actual clients' experiences at the heart of system design.
Like many other topics I search the internet about, someone else has looked at this exact question: what are the social dynamics at play that lead people in power not to consider those whom they have power over. Existing research out of University of California, Berkeley[1] shows a striking inverse relationship between increased power and decreased empathy, decreased ability to read emotions, and decreased ability to adapt one’s behaviors to other people. Interestingly, the research notes that the difference in ability seems attributable to “power-related differences in motivation to affiliate” rather than the actual ability to decode emotions demonstrated by others in general. The data clearly showed that people with higher power who listened to a distressing story actually demonstrated decreased compassion as the lower-powered person telling the story became increasingly distressed. The research offers the possible explanation that people with higher power actively respond by distancing from people with lower power because they are not interested in becoming part of that person’s social support network. It explains why top administrators might be blind to the burnout and stress of their patient serving employees, much less to the concerns of the patients utilizing their systems. It explains why physicians are prone to interrupting patients 11 seconds into a conversation rather than humbly listening and believing individual experiences. It explains why insurance denials can be issued so cavalierly by people who don’t even have the information to understand the complex medical picture. It explains why our major systems, which are designed by people in power, don’t do a great job serving their constituents.
It seems that, in health care, the disconnect between high power and low power people can widen when the stakeholders (i.e. the people who actually can influence the people in power) are also not the system users. In health care, administrators and policy makers answer to insurance companies, stock holders, the medical lobbyists, and drug companies. None of these powerful entities are representing the interests of the patient. And, according to this research, decision makers for these entities are actually less capable of identifying what the interests of the patient might be BECAUSE of the power dynamics that exist inherently in the system design. This feels a little bit like a catch 22, since by nature, systems and policies will always be created by powerful people. However, as I have previously discussed in this blog, empathy and perspective taking can be learned and honed through practice. What if corporate cultures and even legislative bodies prioritized empathy practice in order to ensure they were actually working for the best interest of those they are supposed to represent and care for?
The Harvard Business Review recommends a 10 item self-evaluation inventory[2] for leaders to assess for and prevent movement away from empathy and perspective taking:
Do you have a support network of friends, family, colleagues who care about you without the title and can help you stay down to earth?
Do you have an executive coach, mentor, or confidant?
What feedback have you gotten about not walking the talk?
Do you demand privileges?
Are you keeping the small, inconvenient promises that fall outside of the spotlight?
Do you invite others into the spotlight?
Do you isolate yourself in the decision-making process? Do the decisions you’re making reflect what you truly value?
Do you admit your mistakes?
Are you the same person at work, at home and in the spotlight?
Do you tell yourself there are exceptions or different rules for people like you?
In the health care realm, it would be valuable for all administrators to go through some type of education about using this inventory as part of an annual assessment, in order to ensure that they are conscious of their own ability to attempt to disassociate from their lower powered employees and patients. I would also argue that clinicians should utilize a similar check list in an annual review. There is an inherent power differential in the patient/provider relationship. In order to respond with appropriate empathy and compassion (for the benefit of improved healing, decreased pain, etc), providers should be aware of the natural inclination to respond with distance, rather than connection, when such a power differential exists. Additionally, I think that, if we can train providers to view patients as the ultimate experts in their own experiences, who hold the keys to adherence, correct diagnosis, and treatment success, the power differential could be decreased, allowing providers to have a more natural response of compassion.
As humans, this research is impactful. Inherently, we all have more power over someone. If we know about the inclination to distance from people with lower power in distress, we can check that gut reaction in ourselves and strive to engage differently. In looking to increase compassionate responses, we should look our shared humanity, and use these 10 questions to assess ways that we might feel "above the rules". This can be a top down AND bottom up culture change, and that's the only way we will see true systems change in health care and otherwise.
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