Power Dynamics in the Doctor-Patient Relationship

Title: Power Dynamics in the Doctor-Patient Relationship

Abstract: Power, broadly defined as the asymmetric control of resources, affects nearly all individual decision-making. Yet there is little observational evidence on how power affects real-world behavior and resource allocation. Understanding such power dynamics is especially important in healthcare, where “powerful” physicians make decisions for patients in highly asymmetric information environments. To examine this question, we exploit the plausibly exogenous assignment of patients to physicians in US military hospital emergency departments. Using the difference in military ranks between doctor and patient as a proxy for the power imbalance between them, we show that physician effort and resource use increases with the patient’s relative seniority. Furthermore, within-physician effort is significantly less for patients about to be promoted vs those recently promoted to a given rank. This additional care does not map onto better patient outcomes (30-day ED or inpatient readmission) for higher-ranked patients. We document other interesting effects such as the “power spillover”: when a physician attends to a higher-ranked patient, they concurrently decrease effort for their lower-ranked patients. Taken together, we conclude that the magnitude of the power imbalance in the doctor-patient relationship nontrivially affects patient care, and should be especially considered when making critical clinical decisions for vulnerable patients.