The People on the Plane: What Doctors and Democrats Get Wrong and How We Can Fix It

Have you ever seen the movie “2012”? It is a really goofy apocalyptic spectacle from epic disaster director Roland Emmerich about a world-ending event supposedly predicted by the Mesoamerican count calendar which would end in the year 2012, predicting worldwide cataclysms. It is a guilty pleasure and a deeply silly film. While it shamelessly includes all the tropes of disaster films, there’s one thing in particular, a Sentinel Event if you will, that I think exemplifies a core feature of human behavior.

Honestly, one of the great pleasures of the film for me is that John Cusack of all people, you know, the boombox “Say Anything” guy, becomes an action hero. A respected stage and independent cinema presence up until that time, Cusack is obviously having the time of his life in this rather atypical role.

Then this thing happens. He is trying to get his family out of Los Angeles after a devastating 10.9 Richter scale earthquake along the San Andreas Fault. His ex-wife and kids and his ex-wife’s boyfriend (it’s complicated) are in a small private plane (the boyfriend is a pilot), and Cusack is running to catch up to them. He finally gets pulled into the plane as it ascends, narrowly escaping being crushed by buildings collapsing all around them.

So, here’s what strikes me about this scene: We have gotten to know the people on the plane. We are invested in their success and well-being. They are our family. At the same time, we are seeing hundreds, perhaps thousands of people dying on screen. They may be in the skyscrapers that are falling so we don’t see their bodies, but we know that they’re there, and we know that they are dying.

And let’s face it. We don’t really care. The ONLY people we care about are the people on the plane.

Does this make us callous? Not really. After all, it is only a movie. But it does make us human. We have evolved primarily, perhaps only, to care for those in our immediate circle, our family, our close community. When we have the luxury of assuring that those we love are safe, then we might have the bandwidth to care for the people in the falling buildings.

And it’s something we all do. I know I do.

This fall, when the huge hurricanes Helene and Milton came charging onto the mainland US from the Gulf of Mexico, my heart went out to those affected by the devastation of those monster storms. However, a small, teensy part of me was wondering, especially with Helene, if remnants of that hurricane would come to Saint Louis. I’m sure that’s something we all think about. If a disaster is happening somewhere nearby, might it affect me and those I care about? And when that disaster does veer away from where I live, I know that I silently say to myself, thank God, it got somebody else. But not me.

So, what has this got to do with doctors and Democrats?

I saw my first patient in July of 1978 in Omaha, Nebraska, as a student at the Creighton University School of Medicine. I retired from clinical practice 46 years later at SSM Health Cardinal Glennon Children’s Hospital. I retain an academic appointment at the Saint Louis University School of Medicine as an emeritus professor where I have taught medical students and residents for 27 years. Every profession has a culture, a set of rules, a language, ways of interacting that, though often unspoken, become very clear within a short period of time to those entering that profession.

The Culture of Medicine is solidly based on facts and evidence. We communicate with each other to transmit information based on the best available current research and scholarship. There’s little room for emotion, and that makes sense. When I’ve worked with a learner in the clinical setting, I routinely ask them for their assessment of a patient and their proposed plan of treatment. Often the learner might miss some point that would be important to this evaluation. I would then say something like, “I think you might want to consider this also.” When they do, they are more likely to come up with the appropriate answer. It is all very logical and very professional.

It makes sense for doctors and other healthcare professionals to interact in this way. Unfortunately, I have found, after decades of experience, that this approach does not work well with patients.

Think about the last time you went to the doctor. Even if it was for a routine checkup and you were going primarily to get some questions answered, it was on some level an emotional experience. We get nervous when we go to the doctor. Our blood pressure can go up. This is called “white coat hypertension,” and even I get it when I go in, especially as I’ve gotten older. Are they going to tell me something I don’t want to know? Is there something in my lab work that’s a problem? We can never quite be sure of what to expect and that inevitably makes a healthcare visit, on some level, emotional.

Unfortunately, doctors do not always understand this. We see all kinds of misinformation especially in social media about diet, supplements, and of course, vaccination. Our solution? “When people get accurate information, they will make the correct choice for their health and well-being.” We think that we can transmit information to a patient the same way we do to a medical student who is struggling to come up with an assessment and plan for a patient, and that is simply not the case.

Indeed, an essential tenet of the Culture of Medicine is that learners seek feedback and correction on a regular basis. When we start out, we know that we must sometimes be told that we are wrong in order to help us with our reasoning going forward. While we may be nervous about our performance as learners, we very quickly appreciate that in the Culture of Medicine we should not take correction personally as some sort of insult but rather as an experienced practitioner helping us to hone our skills.

So, what happens when doctors treat patients like professional learners? Let’s take the example of vaccinations.

A mother comes into the office and says to the doctor, “You know, I’ve heard some things about how vaccines can cause autism. It really worries me. I’m not sure that I want Johnny and Clarice to get vaccines.”

The doctor says, “Oh, well, that’s not true. There is no evidence to show a correlation between any vaccination and increased rates of autism in the pediatric population so there is absolutely nothing for you to worry about. Vaccines are safe and effective and have saved millions of lives, so if you love your children, you will get them vaccinated.”

These are all solid, fact-based statements and might very well be appropriate when talking to a medical student or resident, someone accustomed to the communication patterns of the Culture of Medicine. Yet how does that mother, that civilian, feel when hearing that message from her children’s pediatrician?

Disrespected? Patronized? Insulted? Probably. What might a doctor do differently?

A mother comes into the office and says to the doctor, “You know, I’ve heard some things about how vaccines can cause autism. It really worries me. I’m not sure that I want Johnny and Clarice to get vaccines.”

The doctor says, “You know, I’ve heard that too. That is really scary. Thank you for bringing this up. It shows me how much you love your children. Tell me, exactly, what have you heard?”

In this case, the mother can see that the doctor has actually heard what she said, which is, “I’m scared.” This provides an opening for her to provide more information and for the doctor to once again acknowledge the emotions that this mom is feeling, eventually leading to the doctor being able to say, “May I offer you some information on this?”

After doing this for decades, I can tell you that this almost always works to promote effective communication. People do want facts, but first they want to be seen. They want their concerns to be taken seriously. Unfortunately, in the Culture of Medicine, if the premise upon which an emotion is based is invalid, we can sometimes dismiss the emotions as being invalid also.

And this can lead to disaster. If someone says they feel something, we have to believe them. We can’t lead with an attempt to undermine the possible intellectual fallacy that underpins the fear. Starting out with, “Oh, I see your problem. That thing you’re scared of? Well, from a statistical standpoint, it’s exceedingly uncommon. You really don’t have anything to be scared of,” simply never works. It shuts down communication. But if we start out with, “Yeah, I can see you’re scared. I totally get that. And I’m sorry that you’re going through that. Tell me more about what’s going on,” we might actually be able to have a conversation. We can’t get to Facts until we recognize and honor Fear.

So, what has this got to do with Democrats?

According to the Pew Research Center, in 2022, 51% of Democratic voters held a college degree or more while 37% of Republican voters held a college degree or more (and please let me stress here that this is a statistical measure of educational opportunity and attainment, not intelligence), and the candidates of the Democratic Party tend to use, in my anecdotal observation, more of the Language of the Academy than do their Republican opponents.

And they start talking like doctors.

And that’s a problem. To me, this was most apparent in discussions on the economy.

Now, by every academic economic measure, the American economy is booming. Unemployment is at its lowest level in years. The stock market is higher than it’s ever been. Inflation is getting close to the 2% benchmark desired by the Fed. The recession that was so feared in the aftermath of the COVID-19 pandemic never happened. Wages are higher than they’ve ever been. Anyone who wants a job can get one.

Yet many Americans are feeling economically insecure, even scared. Why? Any economy has winners and losers, some people who do better than other people, and some who do much worse. There may be also some free-floating societal PTSD resulting from our shared experience of the pandemic. Inflation that occurred as a result of recovering from the pandemic has taken its toll on the income of those who live on pensions. And of course, we cannot discount the relentless fear-mongering whipped up by Trump and the Republicans.

How have Democrats responded to these fears? Too often by trotting out statistics and charts and quoting the talking points laid out two paragraphs above this one.

As a result, the message that way too many voters heard from Democrats was, “The economy is doing great! You have nothing to worry about!” and many of them concluded, “It looks like I’m going to have to vote for that horrible man who at least it takes my concerns seriously.”

This is especially galling since this is the party that got Bill Clinton (yes, a deeply flawed candidate) into the White House by laser-focusing on James Carville’s mantra, “It’s the economy, stupid.” And there is a huge difference in credibility between stating, “The economy is doing great!” and saying to someone who feels like they’re drowning in debt and economic uncertainty, “You’re doing great!”

While the Democrats quite rightly pointed out the threat to democracy and the rule of law that a second Trump term would present, I think that this represented a secondary, and frankly not especially crucial, concept for a lot of folks who were voting primarily on “kitchen table issues.”

Getting back to my discussion of vaccine hesitancy, I have had colleagues suggest that we can ask parents to vaccinate their child because, “Maybe Johnny has a classmate who can’t receive vaccines because of a medical condition and getting Johnny vaccinated would help to keep this other child from getting exposed to a serious infection.” I have never heard of this argument working. What a parent hears is, “You want me to put my kid at risk for some kid I don’t even know? No, thank you!”

Each of us care most about our own people on the plane. All of us. If we have gotten to the point where we can also care about the people in the collapsing buildings and about apollonian concepts like democracy and social justice, it is likely because we have had somebody somewhere who truly listened to us and took us seriously.

So, yes, we have some tough times ahead, and I am frustrated and frankly scared because we Democrats did not get this over the finish line this year. However, frustrated and scared as I am, I know that it does no good to demonize and to dehumanize and to stereotype people who voted for Trump. Everyone has their own reason for having done this, and as painful as it is, we are not going to get anywhere unless we are willing to listen more than we talk when we interact with friends and family members who voted for him.

And once we have done that, once we have shown them that we hear and understand and respect and validate their emotions, then maybe, just maybe, they will be in a place to listen to us when we say, “And now, may I share with you what scares me?”