Conclusions 301
(2), power is, essentially, wholly suspect. These approaches have re-
sponded to the fact that institutions (including the medical profession)
have tended to be hierarchical, ignoring the relative impact of these
power relations on those served (e.g., patients), and reflecting gender and
race inequalities. The views of the disempowered are crucially impor-
tant. Hence, much critical theory serves as a needed corrective. How-
ever, its implications could potentially go too far in certain domains.
The doctors here offer nuance to these understandings, suggesting
some of these potential limitations, and thus contributing to discussions
about these issues. These doctors were parts of larger systems. Physicians
held much sway, but their power did not explain everything they did.
Even prior to their illness, in some ways they felt weak—unable to
change the system. Their level and use of hierarchy may vary, too, de-
pending on several factors, such as specialty. Surgeons may be more
likely to ‘‘blow off’’ patients, radiologists and pediatricians, less so. Other
factors can shape possible interspecialty differences, including who is
attracted to each of these fields in the first place. Hierarchy was en-
twined, too, with other personal and psychological issues and differ-
ences, and entailed costs. Status can impede optimal self-treatment—the
profession and its hierarchy can jointly fuel denial.
Indeed, even when seriously ill, doctors often prioritized maintenance
of their authority over promotion of their health. The effects of this hi-
erarchy can extend widely in the lives of these individuals and their pa-
tients, colleagues, and institutions. Hierarchy can shape interpretations
of language in doctor-patient interactions (e.g., definitions of time). The
health care system facilitates and promulgates hegemony. Hospitals tol-
erate few dents in physicians’ armor. Hence, questions emerge for fur-
ther studies of whether and when power differentials are legitimate and/or
beneficial in society, and how such determinations are to be made.
Patients here often wanted doctors to be potent. Hierarchy—intrinsic
to the placebo effect, and hence to much of the healing process itself—
can be used for good. As opposed to scholars who are wary of all forms
of power, needs for professional fortitude arise here to abet the placebo
effect and quell anxiety. Certain authors, from Aristotle in Politics to Al-
exander Hamilton in The Federalist Papers, have seen power as not all
bad, depending on how it is used (3, 4). Removing the placebo effect and
discarding its illusion may impede doctoring, making patients less well.
These points may be controversial, but they have surfaced here and