When politics intervenes in the doctor-patient relationship, everyone loses

I was barely a week into medical school at the University of Virginia when I first experienced the tension that arises at the intersection of medicine and politics.

During orientation, one of my classmates asked about the policy for carrying guns on university grounds. Even though Virginia is an open-carry state, I was shocked that my classmate owned a gun and even more concerned that he asked about bringing it to school. Few of my classmates seemed fazed by the question.

I suddenly wondered if I was now in political conflict with my new community of med school students.

In the context of my role as a doctor, I’ve realized that my personal politics have absolutely shaped the trajectory of my training and how I’m learning to treat patients. And that experience may not be uncommon, according to a new study on physicians and their political beliefs.

As doctors, we may gravitate to specialties, maybe even to specific health care systems, based on our personal beliefs, as the study makes clear. I remember rotating through each of the major specialties — surgery, obstetrics and gynecology, medicine, pediatrics, emergency medicine, neurology, and psychiatry — trying to find a discipline where I felt I could do the most good, but also, where I felt most in harmony with my professional community and our mission. I chose psychiatry, and chose to serve at a public hospital.

I spoke to Dr. Matthew Goldenberg, the Yale psychiatrist who coauthored the study, about what these preferences mean.

“Some people gravitate towards fields that are, for example, more socially minded,” Goldenberg said. Doctors who are more drawn to social justice, he said, tend to end up in fields like psychiatry or “pediatrics, which has a rich advocacy history,” he said.

As the New York Times recently reported, your psychiatrist is likely to be a Democrat, and your surgeon, a Republican.

I want to be a good doctor, a doctor who meets my patients where they are and helps them reach their goals. We all do, and that’s why it’s hard to think that our red or blue politics may influence our conversations with patients, or what treatments we offer. But it happens.  Goldenberg’s study also found that while doctors tended to treat most medical concerns — like obesity, smoking, and alcohol use — apolitically, there are big gaps in how Democrats and Republicans approached politicized health issues like abortion, gun safety, and marijuana use.

Somehow political bias seems more benign than other biases — racism or sexism, which societally, we know are wrong. But political bias can also lead to injustice. That tendency of like-minded doctors to cluster in certain specialties can reinforce political bias.

In medicine we learn largely by apprenticeship and gain practical knowledge by following the “see one, do one, teach one” technique.

For example, I’ll watch a more senior doctor interview and counsel a patient on the issues Goldenberg mentioned in his study. Then, when the opportunity arises, I’ll apply what I’ve learned to my own patient and become responsible for teaching junior trainees the same skills. It’s possible that bias could be passed down from teacher to student.

“As  physicians, we need to be aware of what we bring into the exam room,” said Goldenberg. “We are not necessarily neutral arbiters of clinical care.”

It is exactly why we need to be more conscientious in putting politics aside. Otherwise we aren’t putting our patients first.

Awareness helps, Goldenberg said — and I agree. Medical schools are even incorporating these lessons in self-awareness into students’ training. At Harvard, for example, seminars teach health care professionals how to spot implicit bias and how bias impacts the delivery of health care.

To be more aware, I’ve started watching my senior doctors even closer as they counsel patients on politicized health issues. While on my recent neurology rotation, I had a patient who tested positive for marijuana and cocaine. The neurologist I was working with was careful and conscientious — she told the patient that she wanted to understand her choice and not judge her for it. Her goal was to create a space for the patient to be honest.

That subtlety in communication was a good way to start to check my own political bias.

For example, I’m aware that I have biased views on gun safety, especially after a patient threatened to shoot me. If I learn a patient has a gun in the house, I have to get past the gun itself and focus on the health issue at hand — keeping my patient safe from an accidental discharge. I’d give them several options for safe gun-keeping, and be supportive, no matter what choice they made.

In medicine, our community has a lot at stake: health — and one could even say life, liberty, and the pursuit of happiness. The doctor-patient relationship, the foundation of that community, is sacred. It is meant to provide us with the safe spaces we need to be honest about the most intimate and important parts of our lives. All forms of bias have the potential to desecrate that bond and alienate our patients.

I believe in meeting my patients where they are, so I can work with them to create collaborative care plans that respect them as people over partisan agendas. Hate and discrimination have no place in medical practice, but neither does bias. We need to practice with empathy and engage our emotional intelligence to remember that people are different and diverse — but healing relationships need not be red or blue.