M

any medical schools don’t encourage political thought in their students, far less nurture it. That’s a shame because it squanders an opportunity to equip future thought leaders to deal with serious concerns facing the U.S. population, many of which have their tentacles in politics.

In “Experiencing Politics,” a memoir about his 12-year stint in the Massachusetts House of Representatives, Harvard’s John McDonough offers an accessible argument about why health care — and medicine by extension — is an inherently political issue. His argument is partly inspired by Niccolo Machiavelli, the infamous 16th century Italian diplomat. McDonough’s argument can be distilled like this:

  • Human nature is insatiable, so humans quibble over limited resources.
  • Health care is a limited resource.
  • Humans will quibble over health care.

Politics is the way that civilized societies are supposed to decide how limited resources should be distributed. It makes sense, then, to say that health care is a political issue.

advertisement

In medical school, politics — like most “nonmedical” things — tends to be a distraction. Medical students are generally taught to believe that medicine and politics are not overlapping entities. Clinical medicine, especially, is taught in the vacuum of a perfect world, almost entirely divorced from the reality faced by many of our future patients.

To reach a diagnosis, we are often presented with one test to run after another, as if our patients will never have to foot the bill. Have a patient with chronic migraines? Order a CT scan. Can’t see anything unusual on the CT? Run an MRI, just to be sure. A workup like that may very well be needed in certain situations, but it’s rarely emphasized that some patients can barely afford a CT scan, much less an MRI.

Or take the example of allergies, which are even more common. What to do for a child who has gone into anaphylactic shock? Without hesitation, every medical student will say to give the patient epinephrine and write the child a prescription for EpiPens. But with the skyrocketing prices of EpiPens in the last two years, they simply aren’t an option for many families anymore.

What good is teaching medical students to recommend treatments that patients won’t use because they can’t afford them?

Most medical students — and most of their teachers — will say that medicine and health care should transcend political debate. In a perfect world, it probably should. But that doesn’t happen in the real world, where people tend to pick sides. For instance, the signature legislation of Barack Obama’s presidency was the Affordable Care Act. Thus far, the signature goal of Donald Trump’s presidency seems to be to repeal and replace the ACA, with an emphasis on “repeal.”

The disconnect between medicine and politics by medical schools doesn’t mean medical students are apathetic. When President Trump threatened to end the Deferred Action for Childhood Arrivals Act, and eventually did so, medical students across the country began social media campaigns, standing up for their colleagues and loved ones who are dreamers. Similar campaigns at medical schools followed the birth of the Black Lives Matter movement, with schools such as the University of California, San Francisco, arranging die-ins that ultimately culminated in the nationwide White Coats for Black Lives movement.

Yet the culture of medical education fails to emphasize the messy entanglements between medicine and politics. A class on health policy cannot replace classes on pathology or pharmacology, nor should it. But without making policy and public health a major component of medical education instead of a side interest to be pursued on students’ own time, medical schools will continue to churn out exceptionally talented physicians who are exceptionally ill-prepared to deal with the medical bureaucracy and byzantine health care policies that hit them the moment they begin to care for patients. Physicians are no longer just healers, but must also advocates for their patients against these bureaucracies and policies.

I don’t believe there is anything immoral about entering medicine with the sole intent of healing people and hoping to have minimal entanglement with the policy side of medicine. But I do believe that is naiveté to the point of fault. We know from public health research that it is difficult to improve outcomes for many patients without simultaneously improving their socioeconomic circumstances. Physicians who are inadequately prepared to tend to these needs through civic engagement face a steep learning curve that takes a while to summit. This limits their effectiveness as healers.

More than 2,000 years ago, Aristotle concluded that human beings are political animals. I think it’s time that medical schools and medical students acknowledge that reality and do something about it.

Faiz Kidwai is a second-year medical student at the Kansas City University of Medicine and Biosciences. The author thanks Dr. David Annas and Dr. Mary Hon for their contributions to this article.

Leave a Comment

Please enter your name.
Please enter a comment.

  • I’m not sure what in this article has so riled the other commenters – I think it is a fair comment on a profession that has always had difficulty influencing policy. And, yes, the system is geared to producing clinicians not policy wonks: there are other degree programs that focus on public health policy.

    I also think it is time to acknowledge that the present occupant of the White House is woefully unqualified and incapable of fixing our healthcare system or governing for that matter. But, really, should this be surprising? We did vote for a TV personality and an awful one at that. Strike “TV personality”, I should have typed “stable genius”.

    It does not help, of course, that Congress is so rancourously partisan. Oh boy… so many things to fix!

  • Mr. Kidwai, you want to be a politician, move to WashDC with those other self-absorbed goofs.

    The public wants quality medical treatment, not half-baked lectures by amateurs. We already had eight years of that, and now the taxpayer debt is $20,000,000,000,000, worst since WWII, as Asia rises.

  • Your article is…unfortunate.

    THE MEANING OF THIS PARAGRAPH IS EGREGIOUS:
    “Most medical students — and most of their teachers — will say that medicine and health care should transcend political debate. … For instance, the signature legislation of Barack Obama’s presidency was the Affordable Care Act. Thus far, the signature goal of Donald Trump’s presidency seems to be to repeal and replace the ACA, with an emphasis on “repeal.””

    1) The entire UK, and Canadian, health system is collapsing. Mandatory delays for non-urgent surgeries because government run resources cannot handle real world health needs. State as sole provider in an industry is…communism – look how well that turned out; how many more die under its ‘well meaning’ auspices. (And, please don’t lecture me with the fallacy of State military: the State turns to specialist mercenary contractors all the time. See ref: The Production of Security, Gustave de Molinari, 1849, at mises.org).

    2) The ENTIRETY of ethical medicine and politics is properly covered, and constrained by the Hippocratic Oath, or a sufficient equivalent.

    “In a 2000 survey of US medical schools, all of the then extant medical schools administered some type of profession oath. Among schools of modern medicine, sixty-two of 122 used the Hippocratic Oath, or a modified version of it. The other sixty schools used the original or modified Declaration of Geneva, Oath of Maimonides, or an oath authored by students and or faculty. All nineteen osteopathic schools used the Osteopathic Oath.” – source, Wikipedia

    3) I offer some relevant portions of the Hippocratic Oath as a remedy to your article:

    I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.

    I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

    I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

    If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

    4) Politics mean ‘choice’ by which I cast my ‘vote’ for or against some law or regulation, or candidate to represent me in government. You may not use politics to decide whom or how a human is treated for any medical problem, great or slight or cosmetic. You, and everyone as well, may never decide that a human does not get care, or is treated less well than any other, because of your politics.

    There is no ‘nice’ way of inserting politics into medicine, which leads to greater health. Think on this; perhaps write a responding corrective article: be the better professional that we need in the field of medicine.

    Sincerely Yours,

    James, USA

  • Medical Schools should stick to teaching medicine. If politics are mixed in, then students that hold unpopular political opinions will be ostracized and even penalized by professors who hold opposing views. We don’t want the culture in med school to become hostile to certain points of view, such as Google’s or Silicon Valley’s hostility to conservative views. Besides, knowing something about medicine does not qualify someone to make political pronouncements about immigration, or other non-medical subjects. It is would be very arrogant to suppose otherwise.

  • Virchow said it first, “Medicine is a social science and politics is nothing else but medicine on a large scale. Medicine as a social science, as the science of human beings, has the obligation to point out problems and to attempt their theoretical solution; the politician, the practical anthropologist, must find the means for their actual solution

  • The author states that Politics is the way that civilized societies are supposed to decide how limited resources should be distributed – however that’s the concept of economics and not politics.

    In all schools it is a requirement to discuss cost of care of cts and mris – as well as multiple clubs for various political discussions

    Authors also state doctors should push their views on policy on their patients. This can be dangerous.

  • It would be more helpful if time were spent on diagnosis rather than politics. I need a doctor to get me well, not know what is the difference between Republican and Democratic platforms.

Recommended Stories

Sign up for our Morning Rounds newsletter

Your daily dose of what’s new in health and medicine.