Politics should be more like medicine: Column

Inability to put aside differences is destroying our government. Doctors can help.

If you’re a practicing physician, even one running the hospital, you examine the feet of your diabetic patients.

You hold their toes with your fingers. You poke for sensation, check for abrasions and search for other signs of nerve damage. When you walk into a boardroom later that day to review the case, you understand, viscerally, why it’s important that your patient has shelter to sleep, food stamps to eat, a refrigerator to store his insulin.

It’s not because health care costs are rising or because it’s the right thing to do. It’s because you still feel his feet on your hands — and he couldn’t feel your hands on his feet.

As a medical resident, I’m starting to carry moments like this around. When I’m intubating an unconscious man after a heroin overdose, I know he’d have done better at a rehab center than in a jail cell. When I hear a woman crying outside her husband’s hospital room, trembling at the thought of the bill, I wonder why even today so many patients don’t have insurance.

Doctors have a unique perspective into disadvantaged segments of society. We are among the most well-educated, well-compensated and resourceful professionals — but we’re also intimately familiar with the most marginalized populations. We don’t just grasp intellectually what it means for poor families when politicians cut affordable housing initiatives, slash food-assistance programs, or refuse health insurance expansions. We feel it. We’re frustrated when a mother can’t get approval for the medications she needs; we’re helpless when consoling families of dead teenagers in violent communities.

As physicians, we’re uniquely situated to give voice to the voiceless because we know what politicians know, but also because we feel what patients feel. We have stories to tell, particularly for those who can’t tell their own.

But we have other stories, too. They’re stories of the regulatory burden we face every day. They’re stories of metrics and measurements, documenting and box-checking, rankings and red tape. And most doctors, as members of a fiercely autonomous profession, resent this wave of bureaucratic intrusion into medicine.

Medicine, then, is not a force for liberalism or conservatism. Physicians as a group, historically Republican, are now evenly split between parties. Physicians as individuals hold both conservative and liberal views. In some ways, medicine models the balance, compromise and bipartisanship absent in our politics — because it has to.

Providing patient care forces us away from the deepest evils of politics: avoiding nuance, shunning uncertainty, clinging to labels, hating “the other.” Medicine simply doesn’t allow this. If Occupy Wall Street protesters or the Oregon Bundy gang showed up in my office, I’d treat them the same way. I don’t mean with antibiotics. I mean with compassion.

This decency — the ability to put aside differences to focus on problems — is what’s being destroyed in this election. It’s what we lost when John McCain, who as the Republican presidential nominee corrected his supporters’ racially laced comments about President Obama, gave way to Donald Trump, who gleefully broadcasts his fans’ obscenities about Ted Cruz. It’s what we lost when George W. Bush, who emphasized “Islam is peace” after 9/11, gave way to Ben Carson, who opposes any Muslim running for president.

If there’s any tempering force in politics, it’s close contact with groups different from one’s own — the interaction at the heart of medicine. People consciously or subconsciously develop a liking, or at least an understanding, for what we’re familiar with. If we know someone who’s gay or Muslim or disabled, we’re less likely to degrade him or deny her rights. Greater familiarity with other classes, groups or races makes us all more tolerant.

Ultimately, it might be that medicine needs more politics and politics more medicine. As doctors, we don’t do nearly enough to advocate on behalf of our experience — either as caregivers for marginalized patients or captives in a money-centric, regulation-ridden health system. Instead of leveraging our position to influence the economic and social factors affecting our patients, we shy away from the political process.

We know, for instance, that most factors influencing health are present in communities, not in hospitals. We know that your ZIP code more strongly influences life expectancy than your cholesterol, and that substance use and suicides kill more Americans every year. And yet, too often we remain silent.

But the deeper significance of a more politically present medical profession lies not in its advocacy of issues, but in its approach to people. The broader, potentially transformative consequence could be the propagation of an ethos that demands acceptance of those different from ourselves — one that acknowledges that it’s OK for groups to have opposing beliefs, but also for individuals to hold conflicting views that don’t conform to a single ideology.

Our nation’s politics are increasingly rigid and childish. Doctors can be that way, too. But when we care for patients — Democrat, Republican, gay, straight, prisoner, prison guard, gun enthusiast, or gun control advocate — we do so with compassion and respect. Medicine, at its core, is still about recognizing another person’s humanity. It’s a shame that politics no longer is.

Dhruv Khullar is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter @DhruvKhullar.

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