Heyhoe J, Lawton R. BMJ Qual Saf 2020;29:787–789. doi:10.1136/bmjqs-2019-010795 787 EDITORIAL 1 Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK 2 School of Psychology, University of Leeds, Leeds, UK Correspondence to Dr Jane Heyhoe, Quality and Safety Research Group, Bradford Institute for Health Research, Bradford BD9 6RJ, UK; jane.heyhoe@bthft.nhs.uk Accepted 10 March 2020 Published Online First 26 March 2020 To cite: Heyhoe J, Lawton R. BMJ Qual Saf 2020;29:787–789. ► http://dx.doi.org/10.1136/ bmjqs-2019-010110 ► http://dx.doi.org/10.1136/ bmjqs-2019-010179 Social emotion and patient safety: an important and understudied intersection Jane Heyhoe, 1 Rebecca Lawton 1,2 © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. Until the late 1990s, models of decision making and behaviour in the psycholog- ical literature largely ignored the role of emotion. With the work of influential authors, 1–3 among others, came the recog- nition and evidence that our decisions are not always rational. We rely on heuris- tics or rules of thumb that can accumu- late with experience and exposure and that help us to be more efficient (most of the time) but also prone to bias. 4 At the same time, social psychologists seeking to understand what drives our behaviour were also beginning to recognise that, while the costs and benefits of adopting a particular behaviour (eg, smoking or running) were important motivators, the anticipated and actual feelings associated with engaging in these behaviours were often more important predictors of future behaviours. 5 For example, people who felt miserable and embarrassed when running were less likely to run again, despite the knowledge that it was good for them. What was also becoming obvious was that people are not all that good at under- standing how powerful emotions can be in driving their behaviour. Insightful work by Sayette and colleagues, 6 for example, demonstrated that if we ask smokers who were not currently craving a cigarette (cold emotional state) if they could give up, they often said they could, but when craving a cigarette (in a hot emotional state), they were much more likely to be accurate about their inability to give up. There is also evidence that a hot–cold empathy gap is relevant in medical decision making. 7 This last point has important implications for the study of emotions, highlighting that we may need to be cautious about interpreting findings from studies that ask people to recall or imagine how emotion may or may not have influenced their judgements or behaviour or indeed how it will influ- ence their future behaviour. In 2016, we published a call to action, asking researchers if they were ‘brave enough to scratch beneath the surface’ to explore the role of emotion in patient safety. 8 We highlighted the importance of emotion as a precursor to safe or unsafe care, but we also highlighted that patient safety events are a very important source of emotion in themselves. In that same year, this journal published the findings of two randomised experiments exam- ining emotion as a precursor to clinical judgement. In these studies, vignettes containing identical clinical content, but involving patients who would elicit either a neutral or negative physician response, were presented to 63 trainee general practitioners 9 and 74 trainee hospital doctors. 10 Findings revealed that, while there was no difference in the length of time taken to reach a diagnosis, ‘negative’ patients were rated lower than neutral patients for likeability and had lower rates of diagnostic accuracy. This issue of BMJ Quality and Safety includes two studies by Isbell and colleagues, 11 12 which also focus on emotion as a precursor to safe deci- sion making. Both studies took place in emergency departments in the USA, an emotionally charged field of practice. These studies are exciting, adding to a growing body of literature asking chal- lenging research questions about how patients elicit emotions that impact on decision making and patient safety. The first study 11 investigated the impact of emotionally evocative patients and asked 94 clinicians to recall three patient encoun- ters, including one that elicited anger/ frustration/irritation (‘angry encounter’), one that generated happiness/satisfaction/ appreciation (‘positive encounter’) and on January 25, 2022 by guest. Protected by copyright. http://qualitysafety.bmj.com/ BMJ Qual Saf: first published as 10.1136/bmjqs-2019-010795 on 26 March 2020. Downloaded from