One of my graduate school professors proclaimed that what is wrong with our society is that most people have not reached formal operations or have not been in psychotherapy. Formal operations is the stage of development, described by French researcher Jean Piaget, where we learn to take the perspectives of others, to disagree while maintaining a relationship, and to understand that we are not the center of the universe. Psychotherapy is where we look inward, grow, and develop, and take responsibility for ourselves. I thought, “My, aren’t you snotty?” Before too long, I saw that she was right. In my book, interviewees talk about entitlement and unrealistic demands placed on them by patients and by insurance companies. As I wrote, the health care crisis is some combination of the “terrible twos” and adolescence. We are supposed to be a society of adults, who know that we are not the center of the universe, that sometimes we have to wait and be patient, and that we need to see the perspectives of others. Instead, we want what we want, and we want it now. And we want it to be perfect. When we don’t get it, we rebel and lash out. We have an ever-increasing doctor shortage, partially due to our developmental immaturity. The health-care crisis, with its ruptured doctor-patient relationship, is also a crisis in attachment. This is the ability to form, value, and maintain relationships and work through any bumps in them, as researched by psychologists Drs. Mary Ainsworth and John Bowlby. We have a “culture of contempt,” where we cannot tolerate disagreements and are willing to break off relationships because of it. We no longer care about others if we can’t get what we want, and if those others don’t see it our way. Medical sociologists Bultman and Svarsdad noted that the strongest predictor of compliance with medication was the patients’ perceptions of the relationship with their doctors. One of the interviewees in my book said, “It matters the most because a good relationship means compliance and compliance means better outcomes which cost less.” Now, patients switch doctors with apparent ease, as their insurance demands. Further, in his thorough and disturbing book, “The Death of Expertise,” Tom Nichols talks about just that phenomenon. Now, somehow, we magically think that we are all experts. Training and experience don’t matter because we are all “equal,” which somehow makes us equally able to solve problems ranging from plumbing to medicine. Everyone is expendable or replaceable, including our doctors. Patients can just Google and self-diagnose. The sacrifice and dedication of professionals are minimized. Training and expertise matter. While I was earning my Ph.D. in psychology, I earned a master’s in educational statistics and measurement so that I could do research as well as psychotherapy. As I was taking one of my last classes, many of the students continuing on were in my same class. But they were also taking courses working toward the doctorate. I remember that about halfway through the semester, they were already so far ahead of me. They had learned things that I had not learned, and, in fact, still haven’t learned, and they understood the coursework in much more depth. I fell behind quickly. Along those lines, an article on KevinMD addressing the physician shortage and “replacing them with nurses” by Rebekah Bernard, MD, caught my attention. The comments surprised me. I did not expect masters-level practitioners to acknowledge, even champion, the differences in training and experience when compared with physicians. It was impressive and not the least bit self-deprecating or denigrating. They have skills that matter, and they are proud of how they do their jobs as part of an interdisciplinary team. My professor was right. We need to develop formal operational skills. Our doctors are human beings. And they are smart and well trained. The vast majority of them are well-intentioned. The purpose of psychotherapy is on target. We need to look inward and assume more personal responsibility. And Margaret Mead was right: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” We — me and you — are that small group. We experts have to create a change in how experts are viewed. We have to do things that we did not sign up for, that we really don’t have time to do, or perhaps that we don’t even want to do. We have to communicate in layman’s terms and reach out to the general public about how expertise can be helpful to them. The book Our Towns presents a model, which can be widely applied, including to health care. People successfully came together, with a minimum of “posturing,” for their own benefit, as well as the greater good. My own successful experiences include the local grassroots political organizations that have flipped elections and educated the public in impressive ways — including health care. I joined the chamber of commerce, something that I previously could not have imagined doing, and it is beneficial to my practice and to my writing. Recently, I was invited to be the community coordinator of a project that brings people together for civil, respectful conversations about differing opinions. All the while, I am educating community people about health care. We have a lot of work to do to heal our society, including our health care system. I believe that the only way to get it done is to roll up our sleeves, get out there and do it. Margaret Mead was right. Peggy A. Rothbaum is a psychologist and can be reached at her self-titled site, Dr. Peggy Rothbaum. She is the author of I Have Been Talking with Your Doctor: Fifty doctors talk about the healthcare crisis and the doctor-patient relationship. Source
