In the latest episode of Lessons Learned – Wisdom Shared, Dr. Thomas White talks about the pervasive decline of trust in communal and personal relationships. Faith in our bedrock institutions, like Congress, the courts, even our churches, seems to be at an all time low.
Medical and scientific institutions have not been spared from this global distrust. One of my favorite writers, Tom Nichols, has authored a book about the growing hostility to scholarship and research, entitled The Death of Expertise: The Campaign Against Established Knowledge and Why it Matters (2017).
Mr. Nichols writes: “These are dangerous times. Never have so many people had access to so much knowledge, and yet been so resistant to learning anything.”
Why is this? I think, and this is my personal opinion, there are several reasons for the collective skepticism of science and expertise.
First, the most obvious cause is the universal use and abuse of The Internet. An incredible tool, like a hammer it can be used to build or to bludgeon. Brilliant visionaries learned early on that they could make billions of dollars by offering optional, often entertaining searches when someone consults their search engine or “social” page. These optional search offerings run on addictive algorithms that branch out into either wild goose chases, or ominously, the tree of forbidden fruit. What irony! Helpful knowledge is literally at our fingertips, but we can’t stop pressing the buttons while falling into rabbit holes of clickbait.
Second, a corollary to number one, constant internet searching leads to isolation and suspicion. In Tolkien’s The Fellowship of the Ring, the ring bestows power to the wearer, who shuns all human contact so as to exult in the possession of it. Gollum becomes a withered shell of a man, suspecting every person will steal “My Precious”. (I admit my smartphone is a useful tool, but I refuse to call it “My Precious”.)
A defining human need is connection and belonging with other humans. We used to get this need met through shared rituals, religious services, clubs, and what social psychologists call “the Third Place”. The First Place is home. The Second Place is work. Third Places are “spaces outside of home and work where people can gather and socialize, fostering a sense of community.” Think the TV show “Cheers” or the VFW, your church, or your volunteer organization. These third places have not only provided community, they have provided a strong sense of social norms, civility, and cooperation. Third Places are rich in ritual and tradition, and are governed by agreed-upon by-laws and shared, respected rules. Membership in these social institutions are paid for in solemn vows, tithes, dues, pledges, offerings, and commitments that enrich both the member and the institution. In contrast, internet social media is paid for in ads that only enrich the browser company.
Sure, cults and racist tribal organizations like the Ku Klux Klan have existed long before the internet. But now with searches designed to keep one engaged continuously online, the menu of available echo chambers is exponential.
So Third Places are on the decline, often replaced by digital “communities”. Can these internet groups truly satisfy our strong human desire for community, meaning, and belonging? Can a digital community replace our personally trusted senses, namely; Sight, Sound and especially, Touch?
Computer technology has advanced far faster than our primitive human senses can adapt. It seems hopeless to push the genie back in the bottle, or at least tame the beast. What can we as doctors, as family physicians, do to renew the sense of trust that is eroding our relationships with patients and their families?
Certainly we can support our institutions like the CDC and FDA, write our elected officials, and engage with the AAFP and NCAFP. We can encourage our local school systems to teach that science is not an absolute truth, but rather a continuing search for the truth. We can continue to nurture our local “Third Places”. In other words, we can support and defend our institutions.
But as Tom White says, an even more powerful healing weapon is right there in our offices every minute of every day: The Exam Room.
Think of the Exam Room as that most intimate of “Third Places”, a sanctuary, a sacred space. It is in that sacred space where we as physicians can perform the rituals that nurture trust and comfort. The exam room encounter is a ritual of mutual vulnerability and mutual decision-making. It’s a trust incubator.
Tom quoted my other favorite writer, Dr. Abraham Verghese of Stanford University:
“…when you are there with the patient, you are also participating in a timeless ritual. Rituals,…with all its ceremony and tradition are about transformation, about crossing a threshold…When you examine a patient, if you think about it, it is also a timeless ritual, a crossing of a threshold. You are often in a ceremonial white gown; the patient is in a paper gown; the room is decorated with furniture unlike any room in your house or theirs; and in your hand like some shaman you carry stethoscopes and lights and tongue blades and reflex hammers.
You stand there not as yourself, but as the doctor, the latest in that lineage harking back as we said centuries. Your presence, your garb, the setting are all leading the patients to expect a ritual, they are most aware of it, and incredibly, as part of that ritual, they have given you the privilege of touching their body, something that in any other walk of life out of a special context will be considered assault, but they allow it of you. If you listen well and examine them with some skill, …the ritual properly performed earns you a bond, a connection.”
So cross the threshold of each exam room with respect and kindness, and with that sense of awe and apprehension that you remember from your early med school days. That bond, that connection you make there, is the foundation of Trust.
Lee Beatty, MD