Politics in the clinics

As the 2022 elections draw near, tensions continue to rise among friends, families, and communities because of differing political leanings. It’s clear that the stakes are high for all parties involved, and that for many, the elections represent not just a battle among political parties but among opposing moral forces. In the middle of this nationwide debate, a smaller one has arisen thanks to some social media posts on the topic: in the pandemic, health care workers find themselves needing to advocate for the needs of their patients and their fellow workers. This advocacy naturally turns into political leanings and campaigning for candidates. Should doctors, in particular, be allowed to campaign for their candidates? Are they allowed to do so in their clinics, as some have supposedly done? It’s a topic that has caused some friction in the community and some understandable concern for those on the other side of the consultation table.

This is not meant as a rebuttal or an opposition to the originator posts of the topic, but as an offshoot of the heated discussion that followed. I would like too to be able to clarify some concepts that those in the profession might take for granted but which might be opaque to those outside of it. In writing this, I also hope to provide some assurance to patients who might be concerned that their doctors might be bad doctors solely because the latter show their political colors.

What should go unquestioned — what, in fact, has long been part of medical education — is that health and medicine are always political, and physicians have always been free to engage in political life. In the wake of the “should doctors discuss politics with patients” debate, I have seen many laypeople saying that the profession of medicine should be a nonpartisan one, apolitical. This is simply false. Physicians have always been free and allowed by their profession to engage in political life; some ethicists go even further to say that they are obliged to participate in it.

As medical blogger Hayward Zwerling wrote in 2020, it is recognized now that the social determinants of health may be the most important driver of a patient’s health outcomes, and that these determinants are the result of political decisions; this is the reason that physicians may increasingly feel the need to educate their patients on the health repercussions of their political decisions. I have written, with some agitation and repetition, on why health is political, and why the profession is obliged to seek to serve the underserved (“Case studies,” 3/23/20; “Not the time for neutrality,” 11/29/21). This is not a new concept. Rudolf Virchow, scientist and proponent of social medicine born 1821, wrote memorably that “The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.” In short: in expressing political leanings, physicians are not trespassing on some ethical code of the profession. I hope that laypeople may understand that doctors have as much freedom to engage politically as the next person, and that the full exercise of their position may even call for it.

What should also go unquestioned is that no medical professional should allow their political biases to negatively affect the delivery of their service. Perhaps this is what some mean when they say that the profession should be “nonpartisan.” By the code of ethics of the Philippine Medical Association we are “free to choose patients” in non-emergencies, but in all but the most extreme situations, it is unseemly, unethical, and unprofessional to interrupt the delivery of care solely because of the discovery of different political leanings. I am thankful to say that I have not yet encountered a colleague who has done so. One remembers the “Grey’s Anatomy” episode where a physician character overcomes her dislike and renders care to a patient who has a swastika tattoo. Such instances of overlooking personal biases are part of the day to day.

With these two clarifications out of the way, the pertinent point for physicians seems to be whether they can or should initiate political conversations in the clinics with their patients. If they are asked about their political leanings, doubtless they are free to answer. But in the course of their patient consults, can they and should they bring up the 2022 elections?

Whether other professionals can or should campaign for their candidates in the exercise of their professions is beyond my scope here. The relationship between health professional and patient is so specific that it may not be extrapolated to other client-provider relationships. The patients who come to our clinics inevitably stand in a position of vulnerability, of which the physician should always be conscious.

In next week’s column, I hope to share some existing ethical codes that address the matter, as well as some opposing points of view.

kchuarivera@gmail.com