rewards and punishments. As adults, the same benefits persist for the
same reasons, though the authority figures now appear as employers,
judges, and government leaders. Because their positions speak of super-
ior access to information and power, it makes great sense to comply
with the wishes of properly constituted authorities. It makes so much
sense, in fact, that we often do so when it makes no sense at all.
This paradox is, of course, the same one that attends all major
weapons of influence. In this instance, once we realize that obedience
to authority is mostly rewarding, it is easy to allow ourselves the con-
venience of automatic obedience. The simultaneous blessing and bane
of such blind obedience is its mechanical character. We don’t have to
think; therefore, we don’t. Although such mindless obedience leads us
to appropriate action in the great majority of cases, there will be con-
spicuous exceptions—because we are reacting rather than thinking.
Let’s take an example from one facet of our lives where authority
pressures are visible and strong: medicine. Health is enormously im-
portant to us. Thus, physicians, who possess large amounts of know-
ledge and influence in this vital area, hold the position of respected
authorities. In addition, the medical establishment has a clearly terraced
power and prestige structure. The various kinds of health workers well
understand the level of their jobs in this structure; and they well under-
stand, too, that the M.D. sits at the top. No one may overrule the doctor’s
judgment in a case, except perhaps, another doctor of higher rank. As
a consequence, a long-established tradition of automatic obedience to
a doctor’s orders has developed among health-care staffs.
The worrisome possibility arises, then, that when a physician makes
a clear error, no one lower in the hierarchy will think to question
it—precisely because, once a legitimate authority has given an order,
subordinates stop thinking in the situation and start reacting. Mix this
kind of click, whirr response into a complex hospital environment and
mistakes are certain. Indeed a study done in the early 1980s by the U.S.
Health Care Financing Administration showed that, for patient medic-
ation alone, the average hospital had a 12 percent daily error rate. A
decade later, things had not improved: According to a Harvard Univer-
sity study, 10 percent of all cardiac arrests in hospitals are attributable
to medication errors. Errors in the medicine patients receive can occur
for a variety of reasons. However, a book entitled Medication Errors:
Causes and Prevention by two Temple University pharmacology profess-
ors, Michael Cohen and Neil Davis, attributes much of the problem to
the mindless deference given the “boss” of the patient’s case: the attend-
ing physician. According to Professor Cohen, “in case after case, patients,
nurses, pharmacists, and other physicians do not question the prescrip-
tion.” Take, for example, the strange case of the “rectal earache” reported
164 / Influence