The negativity bias in general practice and how to combat it

I recently attended a course and found it really interesting that, after a quick round of introductions, the other GPs had started complaining about general practice before the course had even started. I know that many GPs feel very negatively towards the profession but I couldn’t help the feeling that complaining about it was seen as the common ground. I don’t consider myself the most positive person in the world but I found it really hard to say in front of the others that I liked my clinic, I liked going to work and that I was looking forward to becoming a partner. Don’t get me wrong, there are days when I feel like I want to tear my hair out, that I could be paid better for what I do, that workload is getting heavier and that patients can be devastatingly ungrateful. But I also really like my colleagues and have a laugh with them, I have some pretty funny anecdotes about some of my patients, I love being able to impact change, I LOVE working part-time with no weekends and nights and, more than anything, I LOVE being my own boss. I think I’m happy to take the rough with the smooth but I’m sure I’m not the only GP who is not unhappy?

What is negativity bias?

Negativity bias is a cognitive bias which is thought to protect us; the idea is that we are more drawn to the negatives than the positives in a situation in order to be risk-averse and survive as individuals and as a species. This term was coined by Rozin and Poyzman and has four key components:

Negativity potency – even if a positive event and a negative event had the same magnitude, prominence is given to the negative event. Imagine going on a hike. Do you remember the beautiful scenery or do you remember the water bottle leaking in your bag? At least you’ll screw the cap on tighter next time.

Steeper negative gradient – in the run-up to events, the build-up to a negative event is felt more significantly than a positive event. i.e the dread of a negative event crescendos more than the excitement of a positive event. Think of the day before a dental appointment compared to the day before a party.

Negativity dominance – even if there are an equal proportion of negative and positive events, there is a propensity for negative interpretation. The glass half-empty analogy.

Negative differentiation – this is the idea that negative experiences feel more complicated than positive ones, hence the more emotional admin and time to process them. Imagine a patient sending you flowers to thank you compared to a patient making a complaint about you.

Why can negativity bias be dangerous for family medicine?

I don’t think anyone can argue that family medicine is facing challenging times. The demand after covid has risen astronomically without the funding or the manpower to keep up. Certainly, in the UK, without a change in politics, there is no hope for change in our healthcare system. However, if we allow negativity bias to creep in, we can block innovation, reduce motivation and, more dangerously, negativity bias is very contagious. It makes me feel really sad when younger GPs are fed this doom and gloom by more experienced GPs, starting them on their journey of misery and Eeyore-ness. My biggest recommendation to mentees is to avoid the majority of GP social media groups because invariably they are an echo-chambers of woe. I still think that it is a challenging but very worthwhile profession, that we have a very important role in the healthcare system and we have a responsibility to set the younger generations on the right path.

Negativity bias is still a cognitive bias and can be overridden. Notice your self-dialogue, break the pattern and, most importantly, don’t spread the negativity without thinking. When we can see the situation for what it is and not just through the negativity lens, we can enter a growth mindset and improve our decision-making skills. Sometimes, that decision will be to leave the profession or your situation or your clinic but, dare I say it, the biggest nay-sayers are the ones who are least likely to make the change. Don’t get sucked into it and make sure that you hang around like-minded people. And if you are feeling really negative about family medicine, speak to someone who isn’t. It might not be the right choice for you and that’s ok but make that decision for you and not because others have told you to. And if you have no one to speak to, speak to me – apparently, thirty minutes with me and I can make anyone feel good about being a GP!

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