The difference between trust and authority

For many years, the doctor-patient relationship was simple: they would make a diagnosis, tell you what should be done, and it was expected that you would passively comply (there's a good chap/lass). And why not? After all: they were the experts. What could a layman contribute to solving a problem when the learned doctors had done 10+ years of intensive study to become qualified?

Well, it turned out that being an expert didn't make you immune from making mistakes. By the turn of the century, people were aware that misdiagnosis could and did occur. An 1999 report from the US Institute of Medicine estimated that up to 98,000 patients died due to medical errors each year.

As a result, patients increasingly demand to know more about the process of diagnosis and options for treatment. The latest trend in this participative medicine or empowered patient movement is called “shared decision-making”, or SDM.

Unfortunately, SDM is problematic in circumstances where risks are high and consequences severe. As Lisa Rosenbaum's touching and thoughtful piece in the New Yorker puts it:

... even though [shared decision-making] is an attempt to make medicine more humane, for some patients there is a fine line between gestures of humanity and abdications of responsibility.

Put another way, each person only has one life and it's incumbent on a profession to empower people to choose, not roll the dice on their behalf. This was the primary problem with the authoritarian model of care; people felt things were out of their control.

But somewhat ironically, what people often want with that control is the ability to voluntarily cede their decision to an expert that they trust. The question a professional needs to ask then becomes not: “what do you need to know to make a decision?” but “what do you need to know to trust me?”.

Hopefully the relevance of all this to leaders, managers and other specialist professions is obvious, but if not, let me spell it out. You will make mistakes. Some of them may affect people, and affect them significantly. The fallibility of all kinds of expertise is well-understood today.

So in today's workplace, your team will want to understand your thought-process and may even challenge your decisions. But by the same token, your team are looking for a leader or manager they can trust to do the very best by them when difficult decisions arise. Having confidence in your abilities while being humble about the responsibilities arising from that trust? That's a prescription for being valued and successful in organisations today.

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