The Power of Expectation in Medicine

Rosy Thachil, MD


March 16, 2022

Ever notice that when someone expects something of you or has faith in you, you seem to have that extra push to succeed? Or that you are able to rise to the occasion?

The practice of medicine — no matter your practice setting, specialty, or niche — can be a demanding one. Having strong mentorship can be instrumental to fulfilling your highest potential, career progression, sense of purpose, and even preventing burnout. The need for mentorship is extensively written about across many industries and professions.  

One of the potential psychological benefits of mentorship may be "the Pygmalion effect," the notion that someone's faith in you/expectation of you can translate into enhanced success. A type of positive self-fulfilling prophecy, if you will. 

Origins of the Pygmalion Effect

The phenomenon was originally described in 1968 by psychologist Robert Rosenthal and school principal Lenore Jacobson, whose work in educational research demonstrated that teachers' expectations influenced their students' performance.

In the original study at Harvard, Rosenthal and Jacobson made elementary school teachers aware of the 20% of students who were showing "high potential for intellectual growth" based on IQ examination results. The teachers were blinded, and these students were in fact selected randomly and not on the basis of their performance on the exam (essentially the difference was only in the mind of the teacher). Eight months later, when these students were retested with the same exam, the 20% who the teachers had been told were "high potential" scored significantly higher.

Essentially, when someone believed you could succeed or excel, you were more likely to!

Pygmalion himself is a character from a Greek myth: a sculptor who creates a sculpture of a woman and subsequently falls so "in love" with his creation that he is able to bring it to life. 

The Pygmalion effect (also known as the Rosenthal effect) has powerful implications for teaching, mentorship, leadership, medical training and education, teamwork, career development, and coaching. If someone is invested in you and has high standards for you, you are more likely to adopt the right mindset and subsequently succeed.

A boss or manager's attitudes and expectations toward a worker or employee may influence that employee's output. A teacher's attitudes and opinions of a student may greatly influence that student's performance. A clinician's or patient's expectation of a drug or intervention may influence results (the placebo effect). A mentor's opinions of a mentee may influence that mentee's drive and performance. 

In contrast, in the Golem effect, supervisors, teachers, bosses, and mentors with negative expectations of their subordinates actually cause their students, employees, and mentees to produce poorer quality work or lose self-belief.

In former first lady Michelle Obama's memoir Becoming, she writes beautifully about a pivotal moment in which a college counselor told her she wasn't "Princeton material." While this certainly did not keep her down, as evidenced by her incredible success, these kinds of comments are problematic as they can negatively influence a person's self-worth and question their own abilities. 

"When we expect certain behaviors of others, we are likely to act in ways that make the expected behavior more likely to occur." (Rosenthal & Babad, 1985)

Essentially, there is power in expectation. 

And expectation can transform behavior. 

Implications of the Pygmalion Effect in Medicine

For me, many of my choices, including the ones to pursue medicine and, subsequently, cardiology were tied to people (mentors, sponsors) believing that I could succeed as a cardiologist. The Pygmalion effect underlies the importance of mentorship and support systems throughout our careers. The people that are rooting for you from the sidelines. 

For those of us in academic or teaching environments, the Pygmalion effect can have profound effects on optimizing the mindsets and performance of our mentees, trainees, and students. This can include:

  1. A culture of growth mindset and positive expectations (instead of a culture of failure or pessimism) can result in higher performance. 

  2. Labeling students/mentees as inept or incapable may in turn decrease their chances of success or improvement. These comments and labels can often be internalized by mentees and students. "Forecasting failure" can be damaging. 

  3. How you treat someone and your word choice can have profound effects on that individual's self-image and success. 

  4. Addressing implicit biases and our preconceived notions about someone's abilities or potential is crucial. We must not let stereotyping or bias influence our perceptions of people, especially when it comes to culture, race, gender, age, religion, orientation, or any other attribute. We should assume that with the right guidance and mentorship, all individuals can move closer to achieving their goals. 

  5. The goal is to create positive feedback and causality loops, whereby a mentor's guidance and feedback can be constructively used to enhance performance. 

As we proceed about our roles as clinicians, educators, mentors, leaders, and/or managers, it's crucial to remember that our perceptions of others can often influence their performance.

Disclaimer: The above article is intended for informational purposes only. It is not professional medical advice.

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About Dr Rosy Thachil
Rosy Thachil, MD, is a noninvasive cardiologist and assistant professor of medicine at Albert Einstein College of Medicine. She is a graduate of Jefferson Medical College and completed cardiology training at Mount Sinai Hospital. She is a fellow of the American College of Cardiology.

Dr Thachil's clinical interests including acute cardiovascular care, cardiac critical care, and health disparities. Her nonclinical interests include personal development, blogging, and writing (at


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