BIG SUR, CA—Rankism, defined as abuse and discrimination based on differences in rank, is rampant in our society, and healthcare is no exception, said Robert Fuller, at a summit on humanistic medicine at the Esalen Institute.
Dr. Fuller, author of “Somebodies and Nobodies: Overcoming the Abuse of Rank” (New Society Publishers), believes that issues of rank are, “the one remaining taboo in our culture.” Though not discussed openly, rank abuse occurs in families, schools, religious institutions, corporate boardrooms, government halls, nearly anywhere one chooses to look. Simply put, rankism is what happens when individuals with greater economic, social, or political power in a hierarchical organization use their positions and privileges for personal gain at the expense of those of lower rank.
He believes rank abuse is widespread in healthcare settings. Physician abuse of residents, nurses, and support staff, economic suppression of non-MD healthcare practitioners, the “boot camp” approach to medical training, abuse or condescension toward patients, professional pecking orders among medical subspecialties, and discriminatory allocation of research funds are but a few examples. These issues have been major contributors to healthcare’s economic crisis, as well as the public’s crisis of faith in the medical community.
The solution to rankism does not lie in the abolition of hierarchical organization or the elimination of rank, per se, Dr. Fuller stressed. This only leads to “the tyranny of structurelessness.” Rank-based hierarchies “allow for a certain kind of order and structure that allows things to get done efficiently.”
The answer is found in creating “dignitarian” institutions that recognize the basic dignity of all people in an organization, regardless of their hierarchical rank. This involves, first, recognition of the problem of rankism, and then establishment of safeguards against it. It also requires that those with the highest rank in an organization fulfill their roles with an eye toward the dignity and well-being of those who have low rank.
Dr. Fuller, a physicist by training, said he became interested in these issues when he left a high-profile job as president of Oberlin College. “It got so monotonous being a ‘somebody.’ At first I was glad to be a ‘nobody’ again. But after a while, I realized it was almost impossible to get out of ‘nobody-land.'”
He has been working with several healthcare establishments, including Kaiser of California, and the University of Massachusetts School of Medicine, in addressing rankism in medicine. “It takes enlightened leadership,” he said.
For more information about Rankism and Dr. Fuller’s work, visit: www.breakingranks.net.
