This 'actor-observer asymmetry' involves the tendency for other people to place an undue emphasis on internal characteristics in explaining the actions of another person (e.g., their temperament or intentions) while that person is more likely to explain her own behavior by describing the situation. Thus, I am less likely to look inward and focus attention on my time-planning deficiencies or blame my own personality. Instead, I am more likely to think about the traffic that I just slogged through. It's not that I am trying to avoid responsibility for my actions, or to offer excuses; it's just that my situation is pretty salient to me. Other people don't tend to think of traffic; what they see is somebody who showed up late.
I have oversimplified this attribution effect, of course. Social psychologists have labored for decades to understand the complexities of this phenomenon, which is more or less likely to occur in various contexts (e.g., whether the attribution is negative vs. positive or about ethical behavior vs. trivial action; whether the people are from the same or different cultural backgrounds, etc.). Generally, however, research shows that 'actors' and 'observers' have a tendency to use different explanations for the causes of an agent's actions. It takes some effort to overcome our tendency to minimize the situations that other people are dealing with.
This challenge is all too clear in the care of what we call "vulnerable populations" (...as if being ill does not make one vulnerable enough). These are the millions of poor, and those with limited education and low or marginal health literacy. They are patients with perceptual and/or cognitive challenges (such as, though not limited to, the elderly) and those with mental illness. They are patients whose language and culture are not accommodated effectively by the healthcare institutions they access. In many cases, they might be most of our patients.
Empathy is something that we, as health professionals (and simply as humans), strive to have with other people. We think of empathy as the capacity to place ourselves in another's position and see the world through their eyes. In doing so, we could see the constraints they face and hopefully offer some help in overcoming their challenges. Empathy could help us to listen to the reasons (and not view them as excuses) that prevent our patients from adhering to their treatments. We could help them, instead of judging their commitment or their resolve. And in truly understanding the situations faced by our patients, we often realize that they may be doing the best that they can under the circumstances. For example, we might be surprised to learn that despite having health insurance, many low-income workers delay or avoid getting needed medical care or purchasing prescription medications because the co-payments and deductibles remain financially prohibitive. Or, a patient may delay filling a prescription in order to repair the car and get to work and feed an entire family. It might be natural (...the attribution effect, again) to view a patient who delays care as intentionally non-adherent, but a closer look can reveal the daily challenges faced by that patient. Perhaps we can offer assistance in the form of more affordable medications, or community resources, or encouragement and supportive ideas for coping. At the very least, we can avoid judging another for their actions in a situation we barely understand.
We can best appreciate the situational context of others by offering them a chance to tell their story and truly listening without judgment. We can also learn more about vulnerable populations. The book Scarcity: Why Having Too Little Means So Much examines scientific evidence for the ways in which insufficient resources (e.g., money, food, time, the emotional support of others) can affect how people think and make choices. Written by a behavioral economist and a cognitive psychologist, this informative book offers us the opportunity to empathize with the struggles of those less fortunate than we are.
Empathy can help us to find the commonalities we share with all of our patients including the most vulnerable. We can support our patients' goals to care for their loved ones and to persist despite challenges-- medical and otherwise. And we can better emphasize our partnership with our patients in caring for them.
For health professionals: Please check out my latest QuantiaMD.com program entitled Vulnerable Populations: Communication and Effective Care. I offer some insights into building partnership and engagement, as well as improving adherence and outcomes, in the clinical care of vulnerable populations. This presentation appears on QuantiaMD, a free web and mobile community for healthcare professionals. QuantiaMD is a division of Aptus Health.