My family was sitting at the dinner table the other night, each of us sharing what sort of day we’d had. “Sometimes,” I said, “I have a medication that can save a patient’s life and no matter what I tell them they just won’t take it. And a lot of the time, I just don’t know why.”

My 13 year old looked up from her bowl of chili and said, “Because they’re scared.”

Because they’re scared. I think about this problem every day and I’ve never heard it stated so simply and with so much truth.

I’ve been thinking about fear a lot lately. Last night, we attended a bar mitzvah. We walked hand-in-hand from the parking lot, past the police cars, and through the large cement barriers. We were greeted by the discretely-armed security guards, and inside we said “hi” to the security folks from our own temple, still closed since the attack a month ago.

I sat down in the beautiful but borrowed sanctuary, looking up through the glass cupola. As the sky darkened, I watched wisps of clouds turn pink, and little chimney swifts darting after insects. I held a newly-printed prayer book, our old ones having been ruined by fire, smoke, and water. As the tunes of our prayers filled the room, it felt like home, but also not like home. I held my wife’s hand and quietly wept at the beauty, and tried to forget the fear that helped lead me here.

Fear is a strong and terrible task-master. It drives us toward impulsive and often foolish decisions, but can also lead to beauty. Our community has reached out to us, embraced us, and made a home-away-from-home for us. For some though, it has led to other decisions. I know folks who have decided to arm themselves out of a sense of need. I can cite people statistics—that firearms are the leading cause of death for American children, or that you’re more likely to be killed by your own gun than to successfully defend yourself. But dry statistics don’t have the power that fear does.

The same thing is true in medicine. I’m often caught in a real bind—a patient may be afraid of a treatment I recommend. Citing facts and statistics isn’t always so persuasive. I can reach into my rhetorical tool box and take out fear, but fear is a fickle tool. Fear can cause a sort of emotional “overload” and paralyze our ability to make decisions. Fear can also break the trust between patient and doctor—people come to me for comfort, not fear.

One antidote to fear is trust, but trust is hard work. I’ve been practicing medicine for almost thirty years, and I’m still trying to grasp this dynamic. When patients tell you their fears and their perceived sins, they are giving you an awesome and terrifying power (at least it should be terrifying—if you’re not scared by it, you’re doing something wrong). I’ve had patients ask my opinion on life-saving treatments far outside my expertise because they trust my opinion. It’s humbling.

My thirteen year-old daughter intuitively understands what many of us doctors don’t—that fear and trust are often stronger than knowledge. It’s a fundamental lesson for those of us practicing medicine. We need to recognize fear and work with it, but we cannot use it as a weapon. One of the pillars of medical ethics is patient autonomy and if we try to scare people into making decisions, we’ve violated that ethic.