Regardless of wealth or circumstance, virtually all of us will entrust our lives in a doctor’s hands at one point or another. Doctors study for years and are subjected to gruelling hours, stressful situations and challenging decisions, especially surgeons—their qualifications are highly respected, and rightly so. Surgeons are considered the stars of the medical profession, in fact hospitals still use the word ‘theatre’ to describe the room in which operations take place because the first operations were often done in theatres, literally with tiered seating for audiences to watch. Natural hierarchy clearly exists within medicine, and a healthcare assistant is unlikely to query a nurse’s decision in the same way that a nurse is unlikely to query a doctor’s diagnosis. Trust is unequivocal.
Matthew Syed explores the boundaries of that trust in his book Black Box Thinking. He tells the alarming and poignant story of Elaine and Martin Bromiley: Elaine died during a very minor, routine procedure at a UK Hospital. In the aftermath of her death, her husband, Martin, who was a pilot, explored the similarities between the circumstances that lead to her hospital death and a United Airlines plane crash that happened almost 30 years earlier.
The powerful effect of social and occupational hierarchy prevented the flight engineer from assertively questioning his captain about fuel reserves in the United crash, much like the nursing staff failed to communicate their reservations about a tracheotomy in the case of Elaine Bromiley. Both examples expose the heavy influence of human factors, social influence and to a certain degree, cognitive dissonance.