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Why are maximizing patients more vigilant toward doctors? The mediation role of moral disengagement

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Abstract: Growing social uncertainties have heightened public psychological defensiveness, with particularly pronounced effects in clinical encounters where patients exhibit heightened vigilance toward doctors. This vigilance triggers cognitive and physiological stress responses that, while not immediately causing overt conflict, progressively erode relationship resilience and increase confrontation risks. Thus, patient vigilance represents a critical “psychological latent risk” that transforms psychological opposition into behavioral confrontation. Yet how individual decision-making traits influence this vigilance remains unclear. Our research investigates how maximization orientation affects patient vigilance through moral disengagement, and how doctor friendly behavior moderates this relationship.
Study 1 surveyed post-consultation patients outside hospital settings, measuring their maximization orientation, vigilance toward doctors, moral disengagement, and common ingroup identity. Participants predicted doctors’ potential behaviors in eight typical medical scenarios, with their vigilance levels quantified through standardized coding of these behavioral predictions. Results confirmed maximization orientation increased vigilance through moral disengagement (supporting H1-H2), while excluding common ingroup identity as an alternative explanation.
Study 2 conducted a field survey among outpatients awaiting follow-up consultations with the same target doctor. Participants completed pre-consultation measures assessing maximization orientation and demographic variables, followed by post-consultation evaluations of doctor friendly behavior, vigilance, moral disengagement, and control variables. Vigilance toward doctors was measured using the identical subjective prediction method employed in Study 1. The results not only replicated Study 1’s mediation findings but also demonstrated that doctor friendly behavior significantly moderated the moral disengagement pathway (supporting H1-H4), thereby establishing external validity for our full theoretical model.
Study 3 employed a 2 (maximization orientation: maximizing/satisficing) × 2 (friendly behavior: present/absent) between-subjects experimental design. Following successful mindset manipulation and verification, participants read eight typical medical scenarios (with or without doctor-friendly behaviors) and assessed the likelihood of doctors engaging in behaviors that could harm patients’ interests, which served as our measure of vigilance. Subsequently, participants reported their moral disengagement and demographic information. The experimental results provided causal evidence for our theoretical model, robustly confirming all hypothesized relationships (H1-H4).
Collectively, this study reveals that maximization orientation heightens patient vigilance through moral disengagement, thereby advancing social vigilance research, uncovering novel interpersonal consequences of maximization orientation, and extending moral disengagement theory by empirically establishing its extra-moral motivational effects. Importantly, this study proposes a comprehensive prevention framework for doctor-patient conflicts, comprising: (1) establishing a “prevention-first” conflict management principle; (2) incorporating maximization orientation into risk early-warning indicator systems; (3) integrating the impact of patients’ maximization orientation into healthcare professionals’ communication training; and (4) developing targeted clinical interventions based on the moral disengagement mechanism。

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[V1] 2025-08-13 21:28:46 ChinaXiv:202508.00215V1 Download
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