Trained to Lead with Fear
I was talking with a friend recently. She’s a doctor. Works in an emergency room. We got onto the topic of how the healthcare system operates. And she said something that’s been sitting with me ever since.
From the very beginning, doctors are trained to lead with fear.
Medical school. Residency. The whole way through. You could get sued. This could happen. That could happen. Fear is the foundation.
And it doesn’t stop after training. Every day, she’s measured on how quickly she sees patients. How quickly she gets rid of them. How quickly she finishes her chart. How much she bills.
Not whether anyone got better. Not outcomes. Speed, volume, and billing. That’s what the system rewards. And this is at a non-profit hospital. She said it’s the same everywhere. Every institution is beholden to the same rules. The pressure to move fast is relentless.
I asked her why more doctors don’t push back and use their voices. She had a simple, one word answer. “Fear.”
She has a very clear view of the purpose of the medical system. “We are here to reduce human suffering.” That’s supposed to be the whole point of medicine. But the system she works in isn’t designed to reduce suffering. It’s designed around fear. Fear of lawsuits. Fear of lost revenue. Fear of empty beds.
What struck me most was when she described what happens when you don’t lead with fear.
Although it’s not rewarded, she believes in a different approach. When your first principle is love, she said, you pause. You listen more deeply. You stop, sit down, hold their hand, look them in the eyes, and listen with your whole heart. You give them five to ten minutes of real presence.
And then something happens. People open up. They’re carrying so much. They’re stressed, scared, overwhelmed. If you give them space, they let it out. Sometimes the complaint disappears entirely because what they needed was to be heard.
But it’s not just kindness. She said it’s better medicine. When you actually listen, people reveal the information you need to diagnose them. Instead of hearing “chest pain” and reflexively starting an algorithm of tests, you might hear something else. Like, “Oh yeah, since 1972 my chest has been hurting every time I eat tomatoes.” If you don’t stop to listen, you miss it.
She talked about older patients, like a 75-year-old farmer who doesn’t want to bother anyone. You have to give him time. Tease it out a little. And then he says, “You know doc, this has been going on for a while.” Now, you have better paths to pursue. Not just a bunch of tests and procedures.
Here’s the thing about how healthcare billing works. Hospitals get paid for each test, procedure, and treatment performed. It’s called fee-for-service. The more services provided, the more revenue the hospital generates.
Listening doesn’t have a billing code. But an MRI does. A blood panel does. A referral to a specialist does.
So, when she takes the time to actually hear the patient and figures out what’s going on without running a battery of tests, she’s being a better doctor. But the hospital makes less money. And she’s still measured on those numbers. Not on how many people she helps get healthier.
She believes the love-based approach is better in every way. Better for patients. Better outcomes. Better for the economics.
A little more time up front. More efficient, not less.
But the system doesn’t reward it. The system rewards fear.
I walked away from that conversation realizing I was looking at something familiar.
I’ve been exploring where love and fear show up for a while now. I’ve written about capitalism1 and how extraction and exploitation seem built into its foundation. I’ve written about prisons2 3 4 5 6 and how we put young men in fear-based environments and then act surprised when fear gets amplified.
Now healthcare.
Another system where the stated purpose is one thing, reduce human suffering. But the design rewards something else. Speed. Volume. Billing. Self-protection.
Another system built on a foundation of fear.
This conversation opened up some questions I want to sit with. What does a fear-based healthcare system actually produce? What are the outcomes? And what has it cost me personally to navigate a system built this way?
The data suggests that building systems to protect the wealthy might not even work for the wealthy. More on that in my next post…
This is the first in a series exploring healthcare through the lens of love and fear. Next, I'll look at what this fear-based system actually produces. Then, I'll share my own experience navigating healthcare as a self-employed person. Finally, I'll wrestle with the question: why are so many of our critical systems built on a foundation of fear?