Trained to Lead with Fear

I had a conversation with a friend who is an emergency room doctor. She told me about a system designed to heal people that is actually built on fear. Fear of lawsuits. Fear of missing something. Fear of slowing down in a system that rewards speed and volume.

Her training taught her to order tests, not to listen. The fee-for-service billing model rewards procedures over presence. A fifteen-minute conversation that leads to a correct diagnosis pays less than a battery of tests that covers every possibility. The system incentivizes defensive medicine, not healing.

This connects directly to what I’ve been exploring with capitalism and prisons. Different institutions. Same pattern. The stated purpose is one thing. Reduce suffering. Rehabilitate. Educate. But the design rewards something else. Speed. Volume. Billing. Self-protection. Fear.

My friend described moments where she knew what the patient needed was simply to be heard. But the system couldn’t accommodate that. There’s no billing code for listening. There’s no metric for making someone feel seen.

She practices what I’d call love-based medicine. She takes extra time. She listens before she orders tests. She treats the person, not just the symptoms. It costs her. She sees fewer patients. Her productivity numbers look worse. But her outcomes are better.

This is the first in a series exploring healthcare through the love and fear lens. The data suggests that building systems to protect the wealthy might not even work for the wealthy. More on that in my next post.

Read the full piece on Substack

Learn more about the adventure at www.heart-strong.org