CLINICAL SCENARIO PROLOGUE
You are signing over to a colleague on the COVID-19 inpatient hospital ward. You are stressed after having failed to reach the chief medical resident who did not respond despite repeated texts. You think about mentioning this apparent professional lapse to your colleague. You pause, however, because you are uncertain about the appropriate norm, hesitant around finding the right words, and unsure about a mutual feeling of camaraderie.
Lay and scientific perspectives about gossip diverge widely. Lay definitions of gossip generally include malicious, salacious, immoral, trivial, or unfair comments that attack someone else’s reputation. Scientific definitions of gossip, in contrast, also include neutral or positive social information intended to align group dynamics.1 The common feature of both is that the named individual is not present to hear about themselves.2 A further commonality is that gossip involves informal assessments loaded with subjective judgments, unlike professional comments about patients from clinicians providing care. In contrast to stereotype remarks, gossip focuses on a specific person and not a group.
Gossip is widespread. A recent study in nonhospital settings suggests nearly all adults engage in gossip during normal interactions, averaging 52 minutes on a typical day.3 Most gossip is neutral (74%) rather than negative or positive. The content usually (92%) concerns relationships, and the typical person identified (82%) is an acquaintance. Some of the potential benefits include conveying information for social learning, defining what is socially acceptable, or promoting personal connections. Men and women gossip to nearly the same degree.4 Indeed, evolutionary theory suggests gossip is not deviant behavior and arises even in small hunter-gatherer communities.5Social psychology science provides some insights on fundamental principles of gossip that may be relevant to clinicians in medicine.6 In this article, we review three important findings from social psychology science relevant to team cooperation, the specific transmitter, and the individual receiver (Table 1). Clinicians working in groups may benefit from recognizing the prosocial function of healthy gossip and avoiding the antisocial adverse effects of harmful gossip.7 At a time when work-related conversations have radically shifted online,8 hospitalists need to be aware of positives and pitfalls of gossip to help provide effective medical care and avoid adverse events.
GOSSIP AS TEAM COMMUNICATION
Large team endeavors often require social signals to coordinate people.9 Gossip helps groups establish reputations, monitor their members, deter antisocial behavior, and protect newcomers from exploitation.10 Sharing social information can also indirectly promote cooperation because individuals place a high value on their own reputations and want to avoid embarrassment.11,12 The absence of gossip, in contrast, may lead individuals to be oblivious to team expectations and fail to do their fair share. A lack of gossip, in particular, may add to inefficiencies during the COVID-19 pandemic since exchanging gossip seems to feel awkward over email or other digital channels (albeit a chat function for side conversations in virtual meetings is a partial substitute).13,14
A paradigm for testing the positive effects of gossip involves a trust game where participants consider making small contributions for later rewards in recurrent rounds of cooperation.15-17 In one online study of volunteers, for example, individuals contributed to a group account and gained rewards equal to a doubling of total contributions shared over everyone equally (even those contributing nothing).18 Half the experiments allowed participants to send notes about other participants, whereas the other experiments allowed no such “gossip.” As predicted, gossip increased the proportion contributed (40% vs 32%, P = .020) and average total reward (64 vs 56, P = .002). In this and other studies of healthy volunteers, gossip builds trust and increases gains for the entire group.19-22
Effective medical practice inside hospitals often involves constructive gossip for pointers on how to behave (eg, how quickly to reply to a text message from the ward pharmacist). The blend of objective facts with subjective opinion provides a compelling message otherwise lacking from institutional guidelines or directives on how not to behave (eg, how quickly to complete an annual report with an arbitrary deadline). Gossip is the antithesis of a cursory interaction between strangers and is also less awkward than open flattery or public ridicule that may occur when the third person is in earshot.23 Even negative social comparisons can be constructive to listeners since people want to know how to avoid bad gossip about themselves in a world with changing morality.24
GOSSIP AND THE TRANSMITTER
Gossip can provide a distinct emotional benefit for the gossiper as a form of self-expression, an exercise of justice, and a validation of one’s perspective.25 Consider, for example, witnessing an antisocial act that leads to subsequent feelings of unfairness yet having no way to communicate personal dissatisfaction. Similarly, expressing prosocial gossip may help relieve some of the annoyance after a hassle (eg, talking with a friend after encountering a new onerous hospital protocol). The sharing of gossip might also help bolster solidarity after an offense (eg, talking with a friend on how to deal with another warning from health records).26 In contrast, lost opportunities to gossip about unfairness could be exacerbating the social isolation and emotional distress of the COVID-19 pandemic.27,28
A rigorous example of the emotional benefits of expressing gossip involves undergraduates witnessing staged behavior under laboratory conditions where one actor appeared to exploit the generosity of another actor.29 By random assignment, half the participants had an opportunity to gossip, and the other half had no such opportunity. All participants reacted to the antisocial behavior by feeling frustrated (self-report survey scale of 0-100, where higher scores indicate worse frustration). Importantly, almost all chose to engage in gossip when feasible, and those who had the opportunity to gossip experienced more relief than those who had no opportunity (absolute improvement in frustration scores, 9.69 vs 0.16; P < .01). Evidentially, engaging in prosocial gossip can sometimes provide solace.
Sharing gossip might strengthen social bonds, bolster self-esteem, promote personal power, elicit reciprocal favors, or telegraph the presence of a larger network of personal connections. Gossip is cheap and efficient compared with peer-sanctioning or formal sanctioning to control behavior.30 Airing grievances through gossip may also solve some social dilemmas more easily than channeling messages through institutional reporting structures or formal performance reviews. Gossip has another advantage of raising delicate comparative judgments without the discomfort of direct confrontation (eg, defining the appropriate level of detail for a case presentation is perhaps best done by identifying those who are judged too verbose).31
GOSSIP AND THE RECEIVER
People tend to enjoy listening to gossip despite the uneven quality where some comments are more valuable than others. The receiver, therefore, faces an irregular payoff similar to random intermittent reinforcement. Ironically, random intermittent reinforcement can be particularly addictive when compared with steady rewards with predictable payoffs. This includes cases where gossip conveys good news that helps elevate, inspire, or motivate the receiver. The thirst for more gossip may partially explain why receivers keep seeking gossip despite knowing the material may be unimportant. The shortfall of enticing gossip might also be another factor adding to a feeling of loneliness that prevails widely during the COVID-19 pandemic.32,33
Classic research on reinforcement includes experiments examining operant conditioning for creating addiction.34,35 An important distinction is the contrast between random reinforcement (eg, variable reward akin to gambling on a roulette wheel) and consistent reinforcement (eg, regular pay akin to a steady salary each week). In a study of pigeons trained to peck a lever for food, for example, random reinforcement resulted in twice the response compared with consistent reinforcement (despite an equalized total amount of food received).36 Moreover, random reinforcement was hard to extinguish, and the behavior continued long after all food ended. In general, random compared with consistent reinforcement tended to cause a more intense and persistent change of behavior.
The inconsistent quality makes the prospect of new, exciting gossip seem nearly impossible to resist; indeed, gossip from any source is surprisingly tantalizing. Moreover, the validity of gossip is rarely challenged, unlike the typical norm of lively thoughtful debate that surrounds new ideas (eg, whether to prescribe a novel medication).2 Gossip, of course, can also lead to a positive thrill where, for example, a recipient subsequently feels emboldened with passionate enthusiasm to relay the point to others. This means that spreading inaccurate characterizations may be particularly destructive for a listener who is gullible or easily provoked.37 Conversely, gossip can also lead to anxiety about future uncertainties.38
This perspective summarizes positive and negative features of gossip drawn from social psychology science on a normally hidden activity. The main benefits in medical care are to support team communication, the specific transmitter, and the individual receiver. Some specific gains are to enhance team cooperation, deter exploitation, signal trust, and convey codes of conduct. Sharing gossip might also promote honest dialogue, foster friendships, facilitate reciprocity, and curtail excessive use of force by a dominant individual. Listening to gossip possibly also reduces loneliness, affirms an innate desire for inclusion, and provides a way to share insights. Of course, gossip has downsides from direct or indirect adverse effects that merit attention and mitigation (Table 2).
A large direct downside of gossip is in propagating damaging misinformation that harms individuals.24 Toxic gossip can wreck relationships, hurt feelings, violate privacy, and manipulate others. Malicious gossip may become further accentuated because of groupthink, polarization, or selfish biases.39 Presumably, these downsides of gossip are sufficiently infrequent because regular people spend substantial time, attention, and effort engaging in gossip.3 In society, healthy gossip that propagates positive information goes by synonyms having a less negative connotation, including socializing, networking, chatting, schmoozing, friendly banter, small talk, and scuttlebutt. The net benefits must be real since one person is often both a transmitter and a receiver of gossip over time.
Another large direct limitation of gossip is that it can magnify social inequities by allowing some people but not others to access hidden information. In essence, receiving gossip is a privilege that is not universally available within a community and depends on social capital.40 Gossip helps strengthen personal bonds, so marginalized individuals can become further disempowered by not receiving gossip. Social exclusion is painful when different individuals realize they are left out of gossip circles. In summary, gossip can provide an unfair advantage because it allows only some people to learn what is going on behind their backs (eg, different hospitalists within the same institution may have differing circles of friendships for different professional advantages).
Gossip is a way to communicate priorities and regulate behavior. Without interpersonal comparisons, clinicians might find themselves adrift in a complex, difficult, and mysterious medical world. Listening to intelligent gossip can also be an effective way to learn lessons that are otherwise difficult to grasp (eg, an impolite comment may be more easily recognized in someone else than in yourself).41 Perhaps this explains why hospital executives gossip about physicians and vice versa.42 Healthy gossip tends to be positive or neutral (not malicious or negative), propagates accurate information (not hurtful falsehoods), and corrects social inequities (not worsening unearned privileges).43 We suggest that a careful practice of healthy gossip may help regulate trust, enhance social bonding, shape how people feel working together, and promote collective benefit.
CLINICAL SCENARIO EPILOGUE
Your colleague spontaneously comments that the chief medical resident is away because of a death in the family. In turn, you realize you were unaware of this personal nuance because the point was unmentioned in the (virtual) staff meeting last week. You thank your colleague for tactfully relaying the point. You also secretly wonder what other interpersonal details you might be missing during the COVID-19 pandemic.
The authors thank Cindy Kao, Fizza Manzoor, Sheharyar Raza, Lee Ross, Miriam Shuchman, and William Silverstein for helpful suggestions on specific points.