{"id":79870,"date":"2024-05-21T20:04:43","date_gmt":"2024-05-21T20:04:43","guid":{"rendered":"https:\/\/one.sightlinemg.com\/armytimes\/uncategorized\/2024\/05\/21\/military-doctors-treat-higher-ranking-patients-better-study-says\/"},"modified":"2026-08-08T16:16:24","modified_gmt":"2026-08-08T16:16:24","slug":"military-doctors-treat-higher-ranking-patients-better-study-says","status":"publish","type":"post","link":"https:\/\/one.sightlinemg.com\/armytimes\/news\/your-army\/2024\/05\/21\/military-doctors-treat-higher-ranking-patients-better-study-says\/","title":{"rendered":"Military doctors treat patients who outrank them better, study says"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Service members who outrank their physicians are more likely to receive better quality care at military hospitals than lower-ranking troops, a new study found.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The researchers, who published the findings in the journal <a href=\"https:\/\/www.science.org\/doi\/10.1126\/science.adl3835\" target=\"_blank\">Science<\/a> on May 16, studied power dynamics in the physician-patient relationship. Specifically, those researchers from the University of Texas at Austin and Carnegie Mellon University in Pittsburgh, Pennsylvania used data from <a href=\"https:\/\/www.militarytimes.com\/news\/your-military\/2023\/12\/07\/dod-watchdog-report-warns-of-issues-across-military-health-care-system\/\" target=\"_blank\">military hospital emergency departments<\/a> where some patients outrank their physicians and vice versa \u2014 and how that impacts the quality of patient care.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cWe provide careful, rigorous evidence of the \u2018long shadow\u2019 of power: the idea that power in one domain of life can spill over to unrelated domains (here, from the military to the clinical), causing distortions in behavior and resource allocation in both,\u201d researchers noted. \u201cWe show that the powerful may unwittingly \u2018steal\u2019 resources from less-powerful individuals, in line with other research showing negative spillovers from dominant to marginalized groups in shared spaces.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers used active-duty service members from the ages of 18 to 64, and they monitored physician effort and resource use. The study considered physician effort as a \u201cmeasure of total resources or effort expended by a physician when treating a patient.\u201d Resource use pertained to seven \u201ctangible measures\u201d used on patients during appointments with their physician: any opioid prescription, intensity of evaluation\/management code used, number of diagnosis codes, number of treatment codes, any test ordered, any imaging order and any procedure performed.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The study, using data from 1.5 million emergency department assignments, compared service member patients of the same rank with physicians whose rank was either higher or lower than them, otherwise considered \u201chigher-power\u201d or \u201clower-power\u201d patients. Patients who outrank their physicians received 3.6% more effort by their physician and more resources expended, researchers found.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cIt\u2019s good that it\u2019s not huge,\u201c Stephen Schwab, a University of Texas at Austin Professor and retired Army veteran, told Military Times. \u201cMost physicians are trying to do everything they can for their patients within the bounds of the resources they have, the time they have those patients. We think that this was really an implicit bias rather than an explicit, although there\u2019s no way of testing that.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Schwab said a chief of an emergency department told him it was a matter of human nature kicking into drive, where \u201cyou\u2019re just a little bit more careful when the stakes are higher.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">How does that 3.6% difference materialize? In a \u201clittle bit more time and effort,\u201d Schwab said. Physicians could spend more time talking about the problem that brought a service member into the emergency department in the first place, take more time to write up a more thorough family history or order one additional test.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Those same patients who outranked their physicians also had better medical outcomes than their lower-ranked peers. Those patients were 15% less likely to be readmitted to the emergency department 30 days after their initial treatment.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Findings when those high-power and low-power patients were simultaneously treated by a physician also showed negative correlations for patients whose physicians outrank them. Physicians exerted 1.9% less effort on patients they outranked than on patients who outranked them, and outranked patients had a 3.4% greater likelihood of visiting the emergency department within 30 days or being admitted to the hospital, researchers found.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers also looked into how race and gender determine physician effort among different ranks. Physician effort was greater for all higher-ranked service members than their outranked peers, regardless of race, according to the study. The study found Black physicians provide \u201coff the charts\u201d effort to Black service members that outrank them, and white physicians exerted less effort on Black patients.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Schwab did note that the study wasn\u2019t indicative of whether civilian or military hospitals are necessarily better, rather it looked at the power that can be at play regardless.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cWe\u2019re not comparing the military to civilian health care, because all of our, sort of, anecdotal evidence is that the military is probably more fair than the civilian sector,\u201d he said. \u201cWhat we\u2019re showing is that even in this situation, there\u2019s still an issue and we can learn something about human behavior from this study.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Schwab added that \u201cthese sort of power differences play out in many ways throughout society, and sometimes people don\u2019t even realize the power that they\u2019re wielding.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.militarytimes.com\/news\/your-military\/2023\/12\/07\/dod-watchdog-report-warns-of-issues-across-military-health-care-system\/\" target=\"_blank\">Defense Health Agency<\/a> spokesperson Peter Graves said the agency is reviewing the content of the study.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">\u201cThe Defense Health Agency remains committed to delivering the highest quality of care to all of our patients, regardless of rank, race, color, sex, gender identity, religion, age or any other demographic,\u201d Grave told Military Times in an email. \u201cWe always expect the same high standards to be applied to every patient in an exceptional way, anytime, anywhere, always.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers suggested a number of ways physicians could close disparities in treatment between high and low-power patients. Solutions include \u201ctask shifting, algorithmic support, increasing diversity in the provider workforce, bias training and patient advocacy, in minimizing these disparities and ensuring a health system that provides equitable care to all,\u201d researchers wrote.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A Defense Health Agency spokesperson said the agency is reviewing the content of the 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By:"},"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v26.0 (Yoast SEO v28.1) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Military doctors treat patients who outrank them better, study says - Army Times<\/title>\n<meta name=\"description\" content=\"A Defense Health Agency spokesperson said the agency is reviewing the content of the study.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Military doctors treat patients who outrank them better, study says\" \/>\n<meta property=\"og:description\" content=\"A Defense Health Agency spokesperson said the agency is reviewing the content of the study.\" \/>\n<meta property=\"og:url\" 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