Political discussions can range from a pleasant, respectful sharing of viewpoints to an unexpected stroll through a philosophical minefield. At the least, it’s important for a physician to ask him or herself, “Is it worth the risk to discuss politics with a patient?”
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April 2021
There are other topics that are only tangentially related to patient care, however, or are completely dissociated from the medical topic at hand that the patient may wish to discuss. Among the most potentially risky topics is politics. Political discussions are potentially risky for a number of reasons:
- Alienation of the patient relationship due to difference of opinion;
- Possible misinterpretation of the physician’s viewpoint that could lead to a suspicion of biases;
- A patient’s sense that their opinion doesn’t matter to the physician; and
- A host of other downstream effects if the patient shares the physician’s viewpoints with others.
Political discussions can range from a pleasant, respectful sharing of viewpoints to an unexpected stroll through a philosophical minefield. At the least, it’s important for a physician to ask him or herself, “Is it worth the risk to discuss politics with a patient?”
In the article “Finding Words” in the October 2020 issue of ENTtoday, author Renée Bacher explored the topic of using appropriate words when discussing delicate or controversial topics. When faced with a politically charged question from a patient, the recommendation was to take a moment to think before responding. One patient’s political comment or question may be quite innocuous and easily answered with information, while others may involve significant emotional investment from the patient and a subsequently risky downside for the physician giving an opinion. The gist of the article’s advice, and it is good advice, is “if in doubt, demur.”
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The AMA’s Code of Ethics, Opinion 2.3.4, supports a physician’s right to free speech, including in the political arena, and indicates the appropriate venues for expressing those viewpoints. The Opinion rightfully recommends that boundaries should be placed on physicians expressing their personal political views to patients and their families, with the understanding that, because of the imbalance of power in the patient–physician relationship, patient vulnerability may be adversely affected. There’s a firm statement in the Opinion that “physicians should refrain from initiating political conversations during the clinical encounter,” and that “physicians must not allow differences with the patient or family about political matters to interfere with the delivery of professional care.” This would seem to be a clear mandate.
In the American Academy of Otolaryngology–Head and Neck Surgery and Foundation’s Code of Ethics, the section pertinent to this discussion invokes “character issues” of physicians:
“Patients and society at large place a high level of trust in physicians. Physicians are held to the highest moral standards in the community. This level of trust is based on an assumption that the physician maintains a high degree of personal integrity and adheres to a professional code of ethics. Physicians are expected to be truthful and honest. Otolaryngologists should conduct themselves morally and ethically so as to merit the confidence placed in them. Anything that detracts from the ability of an otolaryngologist to conduct himself or herself in such a fashion should be avoided.”
Why does this section apply to the issue of political discussions with patients? Perhaps the applicability lies in the moral and ethical standards to which we must hold ourselves, so that we must earn respect from the patient through our deeds and words sufficiently that they will place their health and lives in our hands. As otolaryngologists, we carry great responsibility for providing thoughtful, dedicated, and scientifically based medical and surgical care for our patients. Any distraction from the patient’s respect for our moral and ethical character might diminish their trust in our judgment. Is there truth to the old saw that it’s important to be friendly with a patient, but difficult to be friends? Friendliness is very important, but maintaining a professional relationship is fundamental and required.
There are so many issues in our country that are upsetting to patients, causing them anger and anxiety, especially now—the pandemic, vaccinations, masks and social distancing, financial difficulties, difficulty seeing physicians in person, and politics, just to name a few. It’s understandable that patients might wish to discuss issues of concern with their physicians, including issues with political under/overtones. Some patients obviously have very strong thoughts on certain political issues and may seek their physicians’ perspectives. A few may try to impose their viewpoints on their physician, which could result in the hijacking of the clinical appointment. Depending on the intent of the patient’s desire to discuss politics, the physician must quickly perform a risk/benefit assessment and respond in the most appropriate manner.