Where is the Power?

Recently I heard a presentation by Robin DiAngelo on White Fragility: Building White Racial Stamina. A thought-provoking analogy she used in speaking about systemic racism in America concerned the passage of the right for women to vote in 1920 (the 19^th Amendment to the U.S. Constitution). Robin asked the question, “Who gave women the right to vote?” The answer was that men did. Women had no standing to change this, beyond agitation and informal pressure on their husbands. They were locked out of the system perpetuating this inequality.

This power imbalance is an existing reality in our system of racism in the U.S. Like the fish, we have been swimming in our own culture our whole lives, and don’t even realize we are in it. I’m not speaking here about acts of racism but rather of a system created for white Americans for white Americans. A tweak here or there will not create a more perfect union.

But there is also a similar imbalance we have today between healthcare professionals and patients/families. The system truly is stacked against the patient/family in terms of the distribution of power. Unless healthcare professionals invite patients/families not just “to the table” but into the power dynamic, there can be no balance possible. For even with such an invitation to sit at the table, it matters whether there is also a sharing of power. Patient Advisory Committees, by their usual description, can only advise. Who ultimately makes the system decisions? How many stories do we need to hear from healthcare professionals who, suddenly finding themselves as patients in their own system of care, realize how imbalanced the power is even for them as patients?

This is extremely important because healthcare professionals are going to hear some things from patients/families that they might not like hearing. Whether it is in tone or in the critique of procedures and policies by patients/families, it is incumbent on healthcare professionals to listen humbly and not take the very first opportunity to “explain” why this procedure or that policy is really the best approach.

Healthcare professionals must be willing to enter into this relationship with a commitment to receive, reflect, and seek to change. Patients/families must share in the power in the healthcare system or they may likely find themselves dismissed the first time they speak an unpleasant truth.