Health care may be a political topic, but your relationship with your doctor shouldn’t be.
Medicine has long thought of itself as a pure profession: dispassionate, scientific, and unbiased by external influences, especially messy ones like politics. Medical trainees and practicing physicians are taught not to bring their personal political beliefs into the hospital and to avoid politically charged discussions with patients.
The current (extremely contentious) presidential campaign has made that mandate more important than ever; lately, I’ve found myself at least trying to skirt political discussions with patients and colleagues on an almost daily basis. But a new study published in the Proceedings of the National Academy of Science, or PNAS, suggests that, consciously or subconsciously, doctors allow their political beliefs to bleed into the way they care for patients.
But that’s all supposed to occur outside the doctor’s office—or so we’d like to think.
The recent PNAS study suggests that physicians’ political affiliations may influence the kind of care they provide, especially on politicized health issues. In the study, researchers at Yale University asked Republican and Democratic doctors to consider hypothetical patient scenarios. Some scenarios focused on politicized health issues like marijuana, abortion, and firearm storage, while others were apolitical, like obesity and tobacco use.
They found substantial differences in how serious Democratic versus Republican doctors judged political health issues to be as well as how they would go about counseling patients on those issues. For example,
Republican doctors were more likely to say they would urge patients to stop smoking marijuana and emphasize the legal risks of the drug. They were also more likely to discuss mental health aspects of abortion and discourage future abortions. Democratic doctors, on the other hand, were more likely to encourage patients not to keep firearms at home. (There was no significant difference on how doctors viewed or treated apolitical issues.)
The study gives us a glimpse into the partisan psyches of physicians. But a deeper question remains: How extensive are these treatment biases? Could political affiliation affect the way doctors counsel patients at the end of life? Or care for the LGBTQ community? Or treat undocumented immigrants?
These worries have already caused some advocacy groups to encourage patients to seek out doctors who share their beliefs. For example, the Human Rights Campaign, the largest gay rights organization in the U.S., offers online resources for patients to find LGBTQ-friendly doctors. Similarly, the American Association of Pro-Life Obstetricians and Gynecologists provides an online database of pro-life physicians. And some, including the study authors themselves, argue that patients should be able to see their doctors’ political affiliations as easily as where they went to medical school—and seek medical care accordingly.
I think this is a dangerous and misguided idea for doctors to encourage. It’s the correct diagnosis but the wrong treatment plan.
Patients should feel entitled to seek out treatment from doctors who make them feel most comfortable. In select cases, it makes sense for patients to seek out physicians who offer particular services (e.g., immediate need for abortion), and if patients find their doctors’ values or abilities unsatisfactory, they should certainly feel empowered to switch physicians.
But accepting a doctor’s political affiliation as a sweeping proxy for the kind of care he or she provides is an affront to how we should strive to practice medicine.
It’s certainly important to make physicians aware of how and when their biases affect the care they provide, but the solution should not be for patients to seek out doctors—and doctors to seek out patients—who share their political beliefs. Encouraging patients and doctors to pair off by political preference would do far more harm than good. We already live in social and political echo chambers. Let’s not create medical ones, too. Do we really want a future in which Democratic patients avoid Republican doctors and vice versa?
It’s the correct diagnosis but the wrong treatment plan.
A healthier solution is one that grows from within the medical profession—that openly acknowledges its biases; that forcefully embraces its professional responsibilities; and that emphasizes the inviolable sanctity of the doctor-patient relationship above all else.
Entering the medical profession requires doctors to make two basic promises to our patients. The first is: I know what I’m doing. That means providing medical care to the best of our abilities—care that adheres closely to the latest evidence, clinical experience, and expert consensus.
But there are innumerable areas of medicine that require more than just intimate knowledge of the latest risk calculators and randomized controlled trials. They rely on intuition, compassion, and moral integrity. In those circumstances, we are guided by our second promise: I have your best interests in mind. I place your needs above my own.
That means regardless of our personal beliefs—especially on issues of moral uncertainty—we aim to honor patients’ goals, values, and interests, not our own. It means earning trust by expressing a deep compassion—not just for those who have views, lifestyles, and preferences similar to our own but also and especially for those who don’t.
Physicians, like patients, are human, and it’s impossible to leave oneself entirely outside the office. Indeed, doing so has its own perils. Your views are part of who you are, and if you leave that at the door, can you still laugh, cry, and be with your patients?
But it is possible for doctors to be themselves without being political. We should be aware of how our personal political preferences affect patient care—and work to guard against this. Bringing our humanity and empathy to the table, instead of our partisan politics, might allow for deeper connections with patients and more nuanced conversations that bring greater understanding of the people we treat and the care they desire.
In an age of historic political polarization, medicine needs a renewed cultural emphasis that recognizes that patients—not doctors—should drive the care they receive. As professionals, we must place patients’ needs and preferences ahead of our own.
We shouldn’t be asking patients to research their doctors’ political views. We should reassure them, with our actions, that our personal parties are irrelevant to their care. Because in the hospital, they should be.
Dhruv Khullar is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter.