Regard for Power: Part 2

Reader Submissions

A few weeks ago, I wrote a “Friday Reflection” inspired by the quotation: “Regard for power implies disregard for those without power…” The line came from Robert Caro’s 1974 epic biography, The Power Broker: Robert Moses and the Fall of New York. I got carried away and offered up the quote to our readers as a prompt for an essay. I was not surprised by the number and quality of submissions. Thirty three people submitted essays and every one taught me something. I chose three to share, two shorter ones today and one longer one next week. I hope you appreciate them as much as I did. I am awed by the energy and thoughtfulness of our readership. Thank you.

The first was written by Elizabeth Fama, the second by Karen Harris.

"Regard for power implies disregard for those without power…”

Expertise has become a form of power. During my lifetime, Americans have increasingly handed over to experts the uncomfortable or difficult tasks in their own lives, forfeiting power to them. Your child is anxious and unhappy, and instead of reassuring him that this is a normal part of life and of growing up, instead of carving out time to be together, instead of introducing him to a new sport or a hobby and taking him on a trip to expand his horizons and lend perspective, you get him a psychotherapist. The message to your child is, “There is indeed something so wrong with your mental health that I can’t help you.” The message to yourself is, “I’m not the expert of my own child.” Your regard for the expertise of others implies a disregard for your own expertise.

As citizens we’ve ceded a lot of our thinking to experts, but the awful corollary is our disdainful disregard of non-experts—other voters, our co-workers, those idiots on Nextdoor—to the point where we’ve slowly begun policing their thoughts. The experts know more than all of us, and we follow the experts. We keep upstarts in line by broadcasting the harm of their heterodoxy, until they lose their posting privileges, or their friends, or better yet their jobs. This dynamic has the potential to kill freedom of thought and the intellectual checks and balances that should exist in society, including in the health sciences.

There is a chain of trust in medicine. No doctor or practitioner can be a specialist in every field. You must assume that the experts do their jobs well when you recommend them and their treatments to your patients. You rely on your colleagues’ scientific vetting processes and hope that politics and culture don’t inform their policy more than data or lack of data. And yet, the chain of trust was never meant to rob you of your power. Patients need you to continue to ask questions, to maintain a high regard for your own intelligence, to dive in and think critically when research findings feel off, or a policy feels political, or the science too settled. Your patients, and our society, need you to be brave and inquisitive—and sometimes heterodox.

Elizabeth Fama

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"Regard for power implies disregard for those without power…”

Our pandemic response increased cynicism toward medicine. Those who took an oath to do no harm supported recommendations and mandates that caused harm.

However, many more providers were kind, merciful, and courageous in their refusal to enforce policies and to speak out against policies that made no sense for their patients. Sometimes, these actions placed their own careers at the risk.

It is important that we do not regard all of those in power as having no regard for those without. It is our obligation to be informed when it comes to our health and to find a provider we can trust when we need an answer.

Providers cannot take their power for granted. Their years of education and experience affect decisions that pertain to life and death as well as quality of life – often of even greater importance.

Regard for power does not have to imply a disregard for those without. With humility and willingness to view each other with dignity and respect, providers and consumers can have a healthy working relationship built on trust and not fiat.

Karen Harris