Abstract
Medical practice involves moments of wonderful success and moments of serious failure. Because clinicians do not have synchronised careers, these staggered events lead to times when one person’s career seems better than another’s. 1 In medicine, such interpersonal comparisons can influence an individual clinician’s personal sense of well-being and the emotional consequences can span from positive admiration to negative envy. 2 At the negative extreme, persistent noxious envy can contribute to team fragmentation, shortfalls in collegial care and paralysing self-doubt. 3 On a less intense and more common basis, envy may hurt self-esteem, jeopardise a clinician’s peace of mind and add to professional burnout. The possible scenarios that provoke envy are common, diverse and, to some extent, unavoidable (Table 1). 4
Examples of envy towards colleagues in professional and social situations.
Social psychology is the science that examines how people perceive, think about and act towards other people. 5 Studies in social psychology define envy as a constellation of emotions that arise when a person is lacking what another person possesses. 6 The emotions include anger, anxiety, hostility and disappointment. In contrast, jealousy is a constellation of emotions that arise when a person feels threatened by the potential loss of a relationship that the person already enjoys. 7 These emotions are intense; however, envy slants towards longing whereas jealousy slants towards distrust. 8 For simplicity, most research focuses on envy because almost all cases of jealousy are also associated with a degree of envy. 9
The purpose of this commentary is to analyse three robust findings from social psychology science that may be relevant to clinicians who might experience envy from interpersonal comparisons when practising with colleagues. 10 We recognise that envy is a controversial topic in psychology science and we focus attention on rigorous randomised laboratory experiments. 11 Of course, some comparisons may be essential for a profession to achieve ongoing progress by stimulating admiration and ambition. 12 Specifically, positive admiration helps inspire people for productivity (motivation) and also serves to exemplify which achievements are realistic (emulation). 13 An awareness of scientific insights might lessen some misunderstandings in collegial care arising from envy when practising medicine (Figure 1). 14
Directed acyclic graph of envy in medicine.Directed acyclic graph displaying connections between potential causes and consequences of envy in clinical medicine. Nodes are labeled as envy itself (green), contributing factors (yellow), negative reactions (red), personal implications (grey) and clinical consequences (blue). Arrows denote possible causal pathways as informed by literature review, clinical experience and expert consultation. The main implication is how negative social comparisons of attributes relative to colleagues (yellow nodes) might ultimately influence a large number of distinct consequences relevant to patient care (blue nodes).
Direct effects of envy from social comparisons
Psychology science suggests that the basic human emotions are anger, fear, sadness, disgust and joy whereas envy is a blend of emotions dependent on culture, personality and circumstance. Envy arises in nearby social circles, thereby explaining the paradox that people envy a neighbourhood millionaire more than a distant billionaire. 15 Modern practice provides a clear circle for professional interpersonal comparisons, particularly in a complex hospital or large clinic. 16 Because a medical career is characterised by many visible accomplishments, the interpersonal comparisons can contribute to envy towards medical colleagues. Professional training may help dampen some expressions of envy; yet, these innate emotions are intense and cannot be erased.17,18
One classic study of envy involved undergraduates who first completed a simulated personality test and, by random assignment, received either negative feedback or positive feedback about their personality test results. Each undergraduate then evaluated an essay about personal success written by an aspiring college applicant. 19 As expected, expressions of envy by the undergraduates towards the applicant were three times more frequent after receiving negative rather than positive personal feedback (45% vs. 13%, p < 0.001). Moreover, the negative emotion extended to worsening anxiety for themselves and a reduced desire for friendship with the applicant. Evidentially, social comparisons can be painful and potentially undercut future friendships.
In medical care, one adverse effect from envy could be resentment towards a colleague that undermines teamwork. 20 Other dysfunctional responses might include feelings of inferiority, counter-productive withdrawal, nihilistic disengagement or burnout. 21 Electronic media has created boundless social comparisons and opportunities for envy due to a flood of positive portrayals in hospital departmental newsletters, broadcast email messages and social media postings.22,23 These social comparisons may generate feelings of envy (e.g. Facebook depression) and sometimes disparaging reactionary responses (e.g. online trolling).24,25 The adverse effects from extended viewing of social media is a topic of active psychology research. 26
Indirect distracting effects of envy
Many people do not directly act on their feelings of envy, yet remain unreasonably interested in a misfortune experienced by the object of envy. Schadenfreude is defined as the emotional boost to self-esteem when misfortune befalls an envied other person. Schadenfreude tends to be more intense when the object of envy shares similar demographic characteristics and tends to be more intense among men than women. 27 The emotional boost can be powerful despite the observer gaining nothing directly themselves and can be further intensified when the rival’s misfortune seems deserved. 28 Schadenfreude is difficult to assess because the outward behaviour can be hard to detect beyond the brief appearance of an unintentional smile.
A typical experiment studying schadenfreude is based on vignettes describing unfortunate events (e.g. ‘a rushed adult steps on some dog poo’). On a self-reported emotion scale ranging from 1 (feeling not at all bad) to 10 (feeling extremely bad), one study found that the average respondent felt less bad when the event happened to an envied person (e.g. ‘an investment banker’) rather than an unidentified person (3.81 vs. 5.32, p < 0.001). 29 The same pattern of results also replicated in objective measurements from facial muscle electromyography to assess an involuntary smiling reflex. The general pattern is that people feel less compassionate when misfortune befalls an envied person, particularly when the others person’s original success was judged as unfair. 30
The popularity of public scandals highlights the wide appeal of schadenfreude because the vicarious pleasure feels congruent with justice and equity. 31 Medical ethicists, however, condemn schadenfreude as a malicious emotion with no place in medicine. 32 Schadenfreude may be embarrassing since decent individuals feel shame and cognitive dissonance arising from the comfort of knowing a bad thing happened to someone else. 33 Schadenfreude can also be isolating since the uncanny pleasure in another’s misfortune is rarely discussed despite being commonly felt. 34 These adverse effects may further explain why luminaries conceal their fame from clinicians since doing so protects privacy, promotes empathy and avoids schadenfreude. 35
Pre-emptive diversionary actions ahead of envy
Successful individuals can fear the envy of others and take pre-emptive actions. Some strategies for mitigating envy, for example, include self-deprecating comments such as revealing unrelated personal failures, switching the topic, introducing social decoys, thanking supporters or emphasising how success was by only the slimmest margin.36,37 An extreme version of this appeasement is the tradition where elite individuals seem to act honourably and generously towards subordinates (e.g. ‘noblesse oblige’). 38 This psychology also underpins speeches by elected politicians who mention gratitude, humility or other clichés in the aftermath of victory. The core problem is that many successes cannot be shared. 39
A complex experiment of pre-emptive envy reduction involved participants being quizzed along with a partner (who was a secret accomplice of the research team). 40 In all cases, the participant received an undeserved €5 bonus. The experiment indirectly tested a participant’s fear of envy by allocating no bonus (intervention group) or the same €5 bonus (control group) to the accomplice. During a subsequent staged accident by the accomplice, participants who anticipated envy were over three times more likely to offer help (38% vs. 10%, p = 0.010). These findings also replicated with other supportive actions including giving directions and taking time. 41 These studies show that people can be aware of the envy of others and may compensate by adopting prosocial behaviours.
Sophisticated leaders may anticipate and mitigate envy within their medical team. 42 These strategies for reducing envy include justifying the deservingness of a special recognition for the identified recipient, publicising recognitions to many different people (as relevant social decoys) and shared acclaim (for the full group inclusively). 43 In contrast, envy and interpersonal friction may become amplified by assertions that the inequity was unfair or if the displayed modesty seems insincere. 44 The goal is to cultivate a widely shared authentic positive atmosphere that prevents temporary envy from becoming enduring, poisonous and self-destructive. 45 Of course, these strategies require craftmanship and can backfire if vacuous, uninformed or inaccurate.
Discussion
An awareness of the basic features of envy might help prevent some of the toxic consequences from interfering with collegial patient care. 46 This commentary summarises three features of envy drawn from psychology science that are potentially relevant to clinicians. The distinctions concern the direct effects on an envious person, the distractions due to attention towards indirect forces on an envied person and the pre-emptive actions engaged in anticipation of envy (Table 2). An understanding of envy is important because this emotion is rooted in the enduring need for self-esteem, concern for fairness and desire for belonging. 47 In addition, envy is occasionally legitimate because special distinctions sometimes exaggerate small differences in accomplishment. 48
Summary of the psychology of envy towards medical colleagues.
Direct emotional effects from envy.
Distracting effects from schadenfreude.
Anticipatory envy reduction.
Our commentary has limitations because laboratory experiments do not directly extrapolate to daily practice. Statistical analyses examine average effects whereas individuals differ in their emotional profile. Study subjects are often students whereas medical care involves professionals whose advanced training might mitigate some emotional pitfalls. Specific studies focus on particular reactions whereas epidemiologic surveillance is required to test the prevalence of each pitfall. A compact commentary cannot cover all available territory whereas psychology science is boundless. Of course, a complete denial of the envy emotion will not make it disappear any more than closing your eyes would make a visual illusion vanish. 49
A fundamental scientific insight from psychology science is that envy is widely experienced, deeply uncomfortable and socially isolating. Most people will not admit to feeling envy and frequently deny the emotion when asked directly. 50 Similar to earlier research on medical mistakes in patient care, psychology science provides formal evidence so the issue is not dismissed, disguised or demonised. 51 Psychology science can also provide a language and logic for understanding such everyday pitfalls in human interactions for collegial medical care. 52 A priority for future research, therefore, is to directly test whether an understanding of the basic science can lead to less burn-out, more effective care and positive medical culture. 53
Traditional strategies for mitigating envy include immersion in another compelling activity, self-reflecting on future goals rather than interpersonal comparisons or talking honestly with a sympathetic trusted person. 54 In addition, social psychology science has identified one strategy that does not work; namely, overthinking. 55 People often assume that hard thinking over a painful interpersonal comparison could lead to important insights and a potential solution. Such overthinking is beguiling because people believe that they are gaining important intuition despite rarely reaching an epiphany that can channel envy into achievement. Deeply pondering a negative emotion mostly contributes to pessimism, passivity or self-defeat.
Strong emotions have no universal solutions. In addition, profound differences prevail among individual reactions towards another’s success that may limit future research on how to mitigate envy.56,57 Similarly, the effects of a mitigation strategy will depend on circumstances, thereby precluding generic recommendations. 58 Even tangentially related concepts, such as modesty, sportsmanship and authenticity, are culturally determined with no objective definition. 59 As a consequence, science provides some understanding but offers no single proven method for avoiding the harms of envy. 60 Despite these limitations, knowledge and acknowledgement of envy as an emotional pitfall might help foster more collegial care.
Keypoint highlights
Envy from interpersonal comparisons may influence a clinician’s personal sense of well-being and contribute to burnout. Direct effects of envy can contribute to a feeling of threat from surrounding clinical colleagues that undermines teamwork. Indirect effects of envy extend to schadenfreude defined as an unjustified emotional boost to self-esteem when misfortune befalls an envied other person. Diversionary tactics to avoid envy include deflecting attention and offering an authentic sense of modesty.
Clinical scenario prologue
You learn that a colleague in your department has just received an award for teaching excellence. You send a prompt message of congratulations. You secretly wonder why you have no recent awards, whether something has gone wrong with your career and if your efforts in your department are no longer worthwhile.
Clinical scenario epilogue
You take a moment to recognise your envy and then allow yourself a longer pause to reconsider your own accomplishments and other blessings. You may also remind yourself that having award-winning colleagues brings esteem to your whole group, that your colleague stayed humble, and that your own work merits your focused attention.
