The Problem With Power in Healthcare
In the movie Malice, Alec Baldwin plays Dr Jed Hill, a surgeon who gives a famous speech during a deposition in a medical malpractice case. “If you’re looking for God, he was in operating room #2 on November 17th, and he doesn’t like to be second guessed… I am God.”
No one wants a doctor like that. And yet, maybe we do. We yearn for someone capable of healing all of our wounds, fixing what is wrong, performing miracles in the OR. We expect someone to be able to cut into our brains, hearts, and bellies, but somehow also expect that same someone to deny the inherent power of those tasks. Power is fine in the operating room, but we want and need empathy from our doctors in the exam room.
Doctors are inherently in positions of power, surgeons even more so. The problem is, studies suggest that power can destroy empathy. In these studies, subjects who are under the influence of power are less able to see things through others’ points of view. Power impairs mirroring, and mirroring is crucial to developing empathy. Laughing when others laugh, tensing when others tense–these are the things that make us able to feel what someone else is feeling. But that can be dangerous for doctors. One doctor who seemed to be able to master the art of empathy was Dr Paul Kalanithi, the author of the wonderful book When Breath Becomes Air. Unfortunately, it was being diagnosed with cancer (and ultimately succumbing to the disease) that may have allowed him to be empathetic. Cancer is the great equalizer. In his book, Dr Kalanithi said this about doctors “in taking up another’s cross, one must sometimes get crushed by the weight.”
Doctors are asked to take up our crosses of poor health, trauma, and pain every single day. We ask them to heal our wounds and to feel our pain, to be both powerful and empathetic. This is a feat that may be too much for even Dr. Hill. But there may be ways we can help. If we, as patients, can take back some of our power, we can share it with our doctors, and in turn we may improve their ability to be empathetic.
Patients have more and more power today. We are given the opportunity to review our physicians on sites like Vitals and Healthgrades. More and more hospitals and doctors use open records, so we have immediate access to our records. Now that we have the power, we have to use it. We have to be willing to do the work it takes to get well, to share that onus with our doctors. Know the disease, study the options, eat well, stop smoking, treat your depression, and address your reliance on pain pills. None of this is easy, but with increased power comes increased responsibility. It’s time from medicine to go from a paternalistic model to a partnership, with power shared between providers, patients and caregivers as much as possible.
There is so much focus in medicine today on empathy. Medical students are taking improv classes to improve communication and teamwork and looking at paintings in order to develop their observational skills. But if the studies are right, too much power may change doctors brains to such a degree that none of this will help. Ideally, we will strive not to have power over each other, but power over ourselves, doctor and patient alike.
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