Politics and Medicine - Strange Bedfellows

Every individual is influenced by his personal experiences and background. This means that we each bring to our everyday interactions with others our biases, religious beliefs, and even our political agendas. While most physicians do an excellent job of focusing on patients and leaving personal opinion and biases aside, this neutrality can be hard to completely achieve. In this season of intense political debate and a particularly passionate upcoming presidential election, physicians may find it even harder to refrain from sharing their political opinions with others.

In a fascinating article published in Proceedings of the National Academy of Sciences entitled "Physicians' Political Affiliations and Patient Care" (October 18, 2016, vol. 113 no.42 11811-11816), the authors examined whether political beliefs can spill over into nonpolitical domains, such as physician treatment decisions. In the study, 20,000 primary-care physicians in 29 states were linked to a voter registration database to determine their political party affiliation. Surveys with patient scenarios were sent to more than 200 physicians, some of which involved politically sensitive health issues such as abortion, marijuana use, and firearm possession. The study controlled for demographics such as age, gender, patient population, and geography. It is unclear how well the study controlled for other factors, such as religion. The physicians in the study showed little difference in their perception of the seriousness and choices on treatment when it came to issues such as alcohol abuse and depression. However, there were significant differences on more politicized topics.

According to the study, doctors who leaned toward being Republican were more likely to discourage patients from having future abortions, and to discuss the mental health aspects of abortion. They were also more likely to discuss health and legal risks of marijuana. On the other hand, Democrat physicians were less likely to discourage patients from using marijuana or to review potential health risks associated with such use, but more likely to be concerned about home firearm storage practices for patients with young children.

It is not entirely clear whether this study really does measure the political leanings of particular physicians, or if the political leanings themselves are merely reflective of shared beliefs. However, like any other personal opinion, politics is something that must be put aside when a physician steps into the role of provider and caregiver. Certainly, there is no shortage of other ways in which physicians can (and do) share their political opinions in this highly charged voting season.

I recently spoke with a practice trying to handle disputes between its partners based largely on a difference of political opinion regarding the two presidential candidates. What started off as intellectual debate on items such as MACRA, immigration, and term limits on those serving in public office, ended in a heated dispute that divided the practice and created a hostile environment for the staff and patients. In discussing the matter further, it did not even seem that the physicians were far apart in their views, but instead that they got caught up in political hysteria. The practice worked diligently to help the physicians work through the issues and to "agree to disagree." We are also working to implement a policy that prohibits the discussion of politics within the office, or with staff and patients, in terms that specifically could cause friction, incite disagreement, or create disharmony. This will be a work in progress since, of course, in our society we all still have a right to share our opinion. However, as professionals, physicians must be able to put aside their personal views in the workplace and focus on the patient and the practice as a whole.

Over the next week as we head to the polling booths, there is sure to be increasing emotion among many in our country. Whatever the outcome, physicians must continue to work together on issues of national concern to the profession, and to remember the common goals of serving patients and providing the best possible medical care to all.