Pygmalion was a Cypriot sculptor who carved a statue, fell in love with her, and through prayers to Aphrodite, the Goddess of love, made her come to life¹. The Pygmalion effect is the name given to a psychological theory that states that teachers’ expectations from their students affect the latter’s performance². High expectations lead to better outcomes, and low expectations to suboptimal results. This example of a self-fulfilling prophecy is used in the context of organizational behavior, medical education, and nursing care^3-5.

The Golem effect is a negative corollary of the Pygmalion effect⁶. It is a phenomenon in which lower expectations from, or by, individuals lead to poorer performance. The effect is named after the golem, a clay figurine that was brought to life by Rabbi Loew of Prague in Jewish history. Initially, the golem served as a protector and source of security. Over time, however, the golem grew more and more corrupt and violent, and had to be destroyed. This negative self-fulfilling prophecy has been studied in education.

Similar effects may operate in chronic metabolic care, including diabetes and obesity care. While no structured research has been conducted, earlier authors have alluded to the possibility of a Pygmalion effect in diabetes management^7-9. Physicians and other health care professionals who encourage their patients to achieve good control and instill confidence in them usually accomplish better results. Persons living with diabetes/obesity, who are told that they can attain pre-set behavioral and metabolic targets, may be more likely to do so. On the other hand, persons who are discouraged repeatedly (“I doubt if you will be able to manage these goals”) usually remain uncontrolled.

The Pygmalion effect intersects with the concepts of person-centered care and responsible person-centered care. Understanding the preferences, needs, and values of the person being treated and responding¹⁰ to them in a respectful way is the key to person-centered care. This process includes elements of engagement and encouragement, which qualify as the Pygmalion effect.

This effect applies to health care professionals, too. Professionals who are told (by superiors) that they are competent and capable will be more likely to manage their patients successfully. This calls for positive reinforcement of all chronic care ecosystem stakeholders, including caregivers and attendants. The Quintessential Quincunx model also reminds us of the equal importance of all these players¹¹.

The Pygmalion effect is a reminder to focus on upgrading human resources in the health care sector. Chronic disease management depends on motivation for behavioral modification and adherence to therapy¹². A positive attitude, as exemplified by Pygmalion, is an important step towards ensuring better care for our population.

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3. Kierein NM, Gold MA. Pygmalion in work organizations: a meta-analysis. J Organiz Behav. 2000;21(8):913-28.
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12. Kalra S, Chawla K, Kapoor N. Motivation and obesity care. J Pak Med Assoc. 2024;74(1):182-4.