Do You Trust Your Doctor?

Between the absolute insanity of American politics and the catastrophic toll of COVID-19, it seems fair to think that public trust in experts is bottoming out. The political sphere is little else but weaponized polarization. Elected officials as public servants is a quaint idea; now they are tribal figureheads in America’s increasingly unwinnable culture wars. Coronavirus, meanwhile, has exposed the depth to which partisan commitments shape our cultural spirit. No one is exempt: not the conspiracy theory-embracing right, not the scornful and elitist left, and certainly not a compromised media class. Years of education and grooming for leadership or journalism are being wasted in the service of the cheapest imaginable political brownie points. We could say, with some justice, that America is currently without any morally qualified leadership.

But if the unraveling of public trust is a compelling analysis, it’s also more complicated than that. A few months ago Alan Jacobs wrote an excellent blog post on Rush Limbaugh’s attacks on Anthony Fauci. It’s important to keep in mind that this post was written in March, right when most states were scrambling to form a response, public fear and anxiety were peaking, and the threat of mass death was real and urgent. This was, obviously, not the correct time for Limbaugh to play his part in what Tim Nichols dubbed “the death of expertise,” and Alan took him to task fairly and astutely.

I sent Alan an email about his post and he ended up publishing what I sent him. I’m reposting it because it alludes to a theme that I think bears more fleshing out:

You know what the most interesting thing is about Limbaugh’s COVID commentary? The fact that he was recently diagnosed with advanced lung cancer. It stands to reason, does it not, that a man who desperately needs the best experts and credentialed information in this season of his (possibly fading) life would see the value of expert testimony? But in my experience, this actually has little effect on people. My family tree is full of people who practically live in the hospital and eat prescriptions for breakfast, lunch, and dinner, but who are confident that Sean Hannity knows more about anything than any scientist, lawyer, or even theologian. The death of expertise is so nefarious precisely because it’s resistant to cognitive dissonance.

I still think what I told Alan is true and a fair observation. But I’ve started suspecting that I drew the wrong conclusion from it. The fact that QAnon readers go to their checkups and take prescriptions may not mean that the death of expertise is hypocritical, it might mean that the loss of public trust is a different kind of loss than I supposed at first. None of my family or friends who think COVID-19 is entirely or mostly a hoax refuse to see doctors. None of them refuse to get prescriptions, or receive exams, or obtain insurance. If their physician says, “Let’s get your blood pressure under control,” they don’t say, “That’s not what Sean Hannity says.” But that’s because it’s their doctor. If a Biden-appointed chairman of the FDA were to tell them to get their blood pressure under control, they might (and probably would) suspect Big Brother is at it again. But their doctor is different. Their doctor is for them.

I think it’s very significant that COVID-19 has been covered in American journalism almost exclusively with a political angle. One of our church friends is a nurse in the Chicago area, and for the last 6 months she has kept us updated on her work with families infected by coronavirus. She has seen brutal, heartbreaking cases. But she has also seen entire families get infected with mild or even no symptoms. She knows the names of many people who’ve died alone in an ICU, but she also knows the names of children for whom missing school poses a greater threat than the virus ever did. Lindsay interprets what she sees medically, not politically, and her perspective is not easily leveraged in support of any narrative. The mutual church friends we have who lean toward the “hoax” thesis listen to her carefully and I’ve watched their views change as they did so. Why? Because they trust her. They may not trust the medical establishment, and they certainly may not trust journalists, but they do trust their nurse friend.

I think this means that the “loss of public trust” needs to be understood in a specific way. Something real is being lost, but it might be that what is being lost was not entirely well-kept in the first place. To the extent that public trust and the “death of expertise” describe real phenomenons (and they do!), it seems like they mostly describe phenomenons that were only possible in the recent past, and that came to us downstream from technological and sociological transformations that marginalized the role of place and asked for a generic, detached kind of civic life. In other words, I’m not sure anymore that people are supposed to greatly esteem expert cultures. Perhaps trust is a more precious commodity than that, which costs the price of knowledge, proximity, maybe even something like friendship.

And perhaps when public trust is demanded for people and institutions that grow more and more remote, and more and more beholden to invisible stakeholders, that kind of trust is far more fragile and prone to manipulation. Yes, by the rules of strict logic, you need trust in universities and medical boards and licensing laws in order to trust your physician that tells you to take better care of yourself. But those universities and boards and laws are not your doctor. They will not take your call and they will not look at your pain. And sometimes, that’s all it takes.