Dr. Tsai
Is it taboo to talk about politics during the office visit?
My morning routine may sound familiar to many of you: I wake up and get ready for work. Before I step out of my car, I put on my mask. I go inside the office to greet the staff and to get my temperature checked. I don my PPE, and I am ready to start the work day hoping for no disruptions.
My patients come into the office nervous and anxious, but happy to see a friendly face, even with the face shield and mask. Some have not left their homes for months except for these visits. I ask about their safety, health and well-being, and now I also ask if they have enough food, medications and supplies at home.
The pandemic has been isolating, especially for seniors who were unprepared for the Zoom world of 2020. I ask: “How is your family, and is there anything that I can do to help you?”
In rheumatology, we are so fortunate to develop long lasting relationships with our patients. It is such an honor to see and care for them, during good and bad times. Our physician role often leads us to become a trusted friend and dependable ally. As a result, patients are sweet and often ask about our health, well-being and families. So I should not have been surprised when a patient asked, “Who are you voting for?”
“Never talk about politics, religion and money” is a societal recommendation I remember learning as a child to avoid confrontations and discord. Some of these topics are part of routine clinical conversation. We often check to make sure that patients have spiritual and financial resources. Politics, however, is often considered taboo.
The constant media coverage of elections/politics has definitely factored into the added stress and anxiety for my patients, which they self-report during the office visits. As a result, one of my recommendations is to decrease their media exposure to stressful topics.
What do I do when they specifically ask for my opinion and choice?
Possible Outcomes
My dilemma: Do I share my voting ballot information with my patient? One possible outcome could be spending time discussing the hot-button topics circulating throughout the country rather than their health.
Such a discussion could uncover the fact that our views are extremely different and change our future interactions. Perhaps we agree, and our bond is stronger than ever.
Either way, my long office day is likely to be even longer, and the conversation is likely to become intense.
My choice: I chose to discuss the importance of voting with my patient and was completely honest about my vote.
A Broader View
After work, I asked my colleagues what their response would have been, and I was very surprised by their answers. Many of my colleagues said they were apolitical and did not vote; thus, politics is a non-issue/topic during their patient interactions. This led me to wonder whether this was true for doctors across the country.
A 2007 article, “Do Doctor’s Vote?” by David Grande, MD, MPA, David A. Asch, MD, MBA, and Katrina Armstrong, MD, MSCE, analyzed U.S. voting participation from 1993–2002, and showed that lawyers and the general population vote more often than physicians.1 The article also noted this trend has been consistent since the late 1970s.
Voting is a clear demonstration of civic responsibility and community engagement. There are several possible reasons why health professionals may choose not to vote: busy schedules, lack of interest, disengagement, burnout, lack of confidence in the process, a belief their vote won’t make a difference, etc. These arguments against voting would be no different from other members of the general population.
Perhaps health professionals are making a choice to keep healthcare apolitical by aligning with neither side, something that has been very difficult over the past few months.
I would argue that voting is a privilege, and I have voted every year since college.
Healthcare policy is a critical issue politically, and voting for necessary changes should be an important priority and opportunity for our profession. Our practices are affected. And our position gives us a special understanding of how our patients live with the consequences of politically motivated legislation.
Physicians pride ourselves on our professionalism and commitment to our patients. Advocacy remains a core milestone during training. This is another way for us to make a difference for our patients, communities and country.
A Right & a Privilege
The 2020 U.S. election had record voter engagement. By the time this article is printed, all the ballots will have been counted, and we will be preparing for the inauguration. So whether or not you choose to discuss these delicate topics with your patients, keeping in mind the challenges outlined above, it is critical for us to participate in the political process. We may not support the same candidates or issues, but we all have the right and privilege to vote based on our beliefs. It is paramount that each citizen, doctors included, exercise this privilege.
Margaret Tsai, MD, is an associate staff member in the Department for Rheumatic and Immunologic Disease, Cleveland Clinic, Ohio. She is a current member of the ACR Committee on Ethics & Conflicts of Interest.
Reference
- Grande D, Asch DA, Armstrong K. Do doctors vote? J Gen Intern Med. 2007 May;22(5):585–589.
Editor’s note: This article was written for The Rheumatologist on behalf of the ACR Committee on Ethics & Conflict of Interest. If you have comments or questions about this case, or if you have a case that you’d like to see in Ethics Forum, email us at klosavio@wiley.com.