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.

5 thoughts on “The Problem With Power in Healthcare

  1. Great article and very true. Just had a conversation with someone about this regarding a neurosurgeon. He is very business, not the best bedside manner, a bit gruff, but an exceptionally talented physician. He is the one we would want in the OR and are willing to sacrifice the warm and fuzzy. I think in that type of job it might be hard to balance the two.

  2. Power in the hands of a person without empathy has the ability to corrupt and destroy, both individuals and corporations(and countries!).
    I think the physician who is really in tune with patients sees how powerless he/she actually is in curing, healing, changing the course of terminal illness, and then being emotionally available throughout the entire process with a patient.
    My only “power” as a physician is in my relationship with a Higher Being. There are so many unimaginable variables in tackling the disease process, much of it is the patients’ mind. A doctor who feels power in the face of a patient’s mindset has really gone off track. The mind and spirit are the foundations for the healing process and neither can be effectively accessed by a physician or practitioner with a God-complex. And so the healing process never starts on the right foot. The training should be focused on empathy. Many young medical students, with limited life experiences and having their education paid for by parents, have to acquire a depth of understanding of the destitute and chronically ill patient in front of them, who has been bankrupted by medical bills, who is in profound despair and has lost a marriage and relationships as their circle of support loses faith in them, this is what must be absorbed in the heart of the practitioner. It is painful. It adds time to the day. it means more conversation with patients and families.There is always risk in feeling another person’s pain.

    1. Great points as always Aggie. Physicians have to balance power with empathy, and these brain studies show that it may be close to impossible. Every member of the healthcare team (patient, caregiver, provider) has to help.

  3. OK, I waited to watch Malice before I commented. This is interesting because I can see and I can be both sides. I absolutely believe there is a direct correlation between the rapport I have with my caregivers and my health because if I can be comfortable and honest they in turn can can treat me fully and completely because everything is out on the table. Let’s be realistic though. This relationship took years to build and it’s a team that I specifically worked with my PCP to keep all caregivers in the same networks (GYN-PUL-CARDIO-ORTHO) so they could talk to each other for my benefit. BUT by same token I’ve had to reach out to GOD and my orthopedic was honest enough to tell me. After 4 surgeries on one shoulder he admitted the next surgery required a man who wore bigger pants than he. With his recommendation and my own research I found God at a downtown Boston hospital who was an expert in total open reconstructure of the shoulder. I met with him, he had the road map of previous work that was done and what his mission was and it wasn’t easy – not only restore range of motion but I told him I also needed to hit the ball off the tee ⛳️ at least 220 yards to stay competitive. He said he could get 240 yards about of me but it would require replacing some of my ligament with pig ligamentand and cartilage. I said that was fine as long as I didn’t smell bacon on hot days. I gave him the Green Light and said let’s go for it, he did and it was a great success! So as much as I absolutely prefer my group of caregivers who after all these years we are on a first name basis, I don’t hesitate to reach out to GOD and do believe that they believe they are God like and do perform at a level higher than a regular surgeon, as did Dr Hill. All criminal actions aside, Dr Hill was the best of the best. I don’t care that he thinks he is, he’s not my friend and I do not have to see or communicate with him on a regular basis. I’m using him for his expertise just like he is using me as another job performance done better than any of his counterpart could have done.

    1. Pat–your insights are killing me this week! I love everything about this post. There are sometimes the relationship has to come first and sometimes the absolute talent, skill and experience has to come first. However, all doctors and all patients can work towards the balance. Who says a dr with God given expertise and talent can’t work to be a better communicator? And who says a doctor who is a great communicator can’t work to improve their technical skills? We will always have our own sets of talents, but we can also always get better. Thanks so much for taking the time to respond to this one!

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