We are taught to respect and obey authority. Policemen, teachers, ministers, parents – all may have been sources of authority in our young lives. “Because I said so” is a phrase you may have heard from a parent when you questioned an order. Obeying authority is a necessary part of learning the rules of society.

A shocking experiment
You may know of this experiment. A psychology department recruited paid volunteers for an experiment on memory. A research scientist in a lab coat and another volunteer (the learner) were in the room when the paid volunteer entered. The paid volunteer was told the study was about the effects of punishment on memory. The paid volunteer was instructed to deliver electric shocks to the learner for each wrong answer he gave. The voltage went up after every wrong answer. As the voltage increased, the learner began telling the paid volunteer that he was receiving painful shocks. The scientist instructed the paid volunteer to continue the experiment. The paid volunteers continued to deliver shocks to the learners even though the learners were screening, kicking and pleading for mercy with every subsequent shock. The researcher finally stopped the experiment when the learner was receiving 450 volts of electricity.

This experiment was performed in 1963 at Yale by Stanley Milgram. But the study did not actually deliver shocks; the learner was an actor, and the study was about obedience to authority. About two thirds of the subjects administered every shock up to 450 volts, no matter how much the learner begged for mercy. Milgram concluded that we had a deep seated propensity to obey authority.

Given our conditioning to follow the directives of authority figures, it is no wonder that standing up to an authority in health care is a frightening act for some people. When the attorney asks the defendant, “Did you question the order or decision?“ the response may be, “I thought he must be right. He was the attending physician, fellow, department chair, charge nurse – “ Fill in the blank. I’ve seen cases with frightful results because of blind, unquestioning obedience to authority.

Airplanes and Speaking Up
The airline industry has gotten this point worked out. A few years ago I attending a program put on the New Jersey Society for Health Care Risk Management. The pilot/nurse presenter showed us video after video of airplane accidents caused by failing to question orders. Tragic accidents were caused by failing to question a captain. The airline industry addressed this by actively encouraging anyone who had a doubt about the safe course of action to speak up. The term “crew resource management” addresses the communication errors that cause accidents.

The Joint Commission has a whole campaign encouraging patients to speak up.

Authoritarian-minded healthcare providers who don’t like being questioned are having to deal with the new realities of healthcare practice. The team approach, the collaborative approach encourages team members to speak up. But have we eliminated blind obedience as a source of medical error? Not by a long shot.

Is it a good thing to tell your children and grandchildren, “Because I said so?” Should you be teaching them to question authority or obey it? What do you think?

Med League is a legal nurse consulting firm that assists attorneys handling cases involving medical negligence, personal injury and other litigation with medical issues at stake. Call us for assistance.