Talking Politics with Patients

Synopsis

  • Physicians are professionally obligated to help their patients understand their treatment options and how to improve their health.
  • As political decisions impact our health, don’t physicians also have an obligation to ensure that their patients understand this connection?

_______________

A Physician’s Obligation to Discuss the Political Ramifications of Science with Patients

I walked into my exam room to see a patient I first met two decades ago. When we first met, his medical problems included poorly controlled type 1 diabetes, high blood pressure, high cholesterol and a substance abuse disorder. Over the years our healthcare system has served him well as he has remained free of diabetic complications and now leads a productive life. Watching this transformation has been both professionally rewarding, personally enjoyable, and I look forward to our periodic interactions.

At this visit, he was sporting a MAGA hat. I was confused. How can my patient, who has so clearly benefited from America’s healthcare system, support a politician who has tried to abolish the Affordable Care Act, used the bully pulpit to undermine America’s public health experts, refused to implement healthcare policies which would mitigate COVID-19’s morbidity and mortality, and who minimizes the severity of the coronavirus pandemic every day. Why does he support a politician whose healthcare policies are an immediate threat to his health and longevity?

My brain says, “You are the physician this patient trusts to take care of his medical problems. You must teach him that COVID-19 is a serious risk to his health and explain how the President’s public health policies threatens his health. You must engage in a political conversation.”

It is currently taboo for physicians to discuss politics in the exam room, especially when political opinions are discordant as it risks creating a rift in the patient-physician relationship. Reflexly, I answer myself “Do not engage in a political discussion, you need to deal with his immediate health issues.”

During the visit, we reviewed his medicines and test results and agreed on a treatment plan. At the end of the visit, I told him that it is in his best health interest to wear a mask, socially distant, wash his hands frequently, and defer visiting his favorite bar and gym. I consciously decided not to address his support for the President.

Back in my office, I reviewed the encounter and immediately had misgivings about my decision to avoid discussing the health ramifications of his political proclivities. I knew he was mistakenly informed about the science of COVID-19, as his primary source of information was Fox News and his peers. I was concerned that this misunderstanding led him to support a politician whose public health policies will adversely impact his health.

Every day physicians teach their patients the scientific truths they must understand to enable them to make informed healthcare decisions. Is it not also a physician’s responsibility to teach their patients the science underlying relevant public health policy and explain that there is a linear connection between political choices, public health policies, and their health and longevity? Would not a more comprehensive understanding of this relationship enable our patients to make more informed political decisions, including the option to choose political leaders who will implement better healthcare policies?

While politics has become hyperpolarized, most patients still believe their physicians tell the truth about science and medicine; thus physicians are in a unique position to educate their patients about the ramifications of science.

By selecting me as his physician, he was implicitly telling me that he had confidence in my judgment. In return, I should have emphasized that the coronavirus is an immediate risk to his health, I should have explained how COVID-19 spreads and how he can reduce his risk. I probably should have breached the “no politics in the exam room” taboo and told him that the President’s refusal to implement public health measures recommended by every public health expert has resulted in the needless death of tens of thousands of Americans and is part of the reason that 1,000 Americans die from COVID-19 every day. I should have explicitly connected the dots and stated that the President’s COVID-19 public health policy is an immediate threat to his health.

The medical profession now understands that social determinants of health are probably the most important driver of a patient’s overall health and these determinants are largely the result of political decisions. Clearly, we have a professional responsibility to teach our patients the science underlying their health issues. Don’t we also have a professional obligation to ensure that our patients understand the health ramifications of their political choices? If that is the case, do we not have a professional obligation to initiate a conversation about the political issues which impact our patients’ health?

If we fail to breach the taboo of “talking politics” in the exam room, are we not shirking our professional responsibilities to our patients and society?

Hayward Zwerling, M.D.

September 24, 2020

This opinion piece also appears on KevinMD.com, The Health Care Blog and MedPageToday

___________________

Dying in a Leadership Vacuum

The Editors of New England Journal of Medicine, 10/8/2020

“…our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.”

N Engl J Med 2020; 383:1479-1480