It may be a function of advancing age but I find myself increasingly thinking about how institutional modern medicine operates these days.

Think about this scenario.

A middle aged patient experiences an event she considers a possible cardiac incident. As soon as possible she makes an appointment with her GP. The doctor orders a series of tests and the patient books a follow-up appointment to review the results.

In the follow-up appointment the results come back for the most part indicating a healthy heart. The patient has one question.

“What about the cholesterol numbers? Do they seem a bit high?”

The doctor circles one of the two cholesterol numbers and replies, “No, this is the important number and it is fine.”

Patient: “So you don’t think I need to make any dietary changes or worry about my levels?”

Doctor: “No you are fine.”

The patient returns home still wondering about her cholesterol levels. She googles cholesterol levels and becomes convinced that her doctor has circled the wrong number report and has missed a number that is well outside the acceptable level. She phones her doctor to raise her concern. The receptionist instructs the patient to email the doctor. After five days the patient receives an email from the doctor’s receptionist saying that the question is too complex to discuss by email and the patient should make another appointment.

The first important thing about this incident is that the patient did not simply accept the medical professional’s answer without question. The patient went home and made herself informed about her situation. When the patient became concerned, she pushed until she was more fully satisfied with the response.

Institutional leaders today cannot afford to throw their weight around. It no longer works simply to assume that the fact that I hold a position of authority, guarantees respect. I will be questioned and challenged by people who may not share exactly my view.

I must not only grudgingly accept the fact that I will be questioned, I must be glad. I must encourage the kind of independent thinking that refuses to allow me to assume that everyone must agree with my opinions simply because of my role in the institution.

In a culture that has deconstructed every power structure and every position of privilege, respect must be earned. It does not automatically adhere to anyone simply on the basis of institutional status.

Respect is only earned by being given. I will be respected by people I respect.

The second critical thing in the medical scenario above, is that the medical professional appears not to have listened carefully to the patient. The doctor was rushed and did not hear the concern expressed. From a position of professional authority, the doctor simply told the patient the answer.

Telling does not work. People in authority must start with deep and careful listening. They must be willing to enter into the world of those their institution exists to serve. They must let go of the privileges of their position and be sensitive to the world in which people live, hearing carefully peoples’ concerns, and perceptions.

Many of the terrible acts carried out by authorities in the past could have been avoided if the people in positions of influence had started with genuine listening. Violence occurs when we begin from a place in which we believe we know the answers and are willing to impose our answers upon poor people who are in need of the enlightenment that we alone can offer.

In an interview that accompanies the DVD of Terrence Malick’s film “The New World,” one of the actors says,

Think how different history might have been if the colonists who came over from England in the seventeenth century had chosen to listen to the people they found already inhabiting this land.

Think indeed! What if those who came from distant lands had asked the inhabitants, “What is it like to live in this place?” “What have you learned that might help us live in tune with the realities of this geography?” “What skills will help us live in harmony with those who live here already?”

The new institutions that must emerge in our day need to be oriented towards the people they exist to support rather than entrenched positions of privilege and power. Institutions must seek to hear deeply the realities of the world in which people live and to set them free to assume responsibility for their own well-being.

Sadly, the skills of respect and listening are not the ones I was taught when I was training for leadership in the institution of the church. It is not clear to me that they are the skills most professionals are being given in their training today. But they are the essential skills for building healthy institutions able to work for the well-being of society.