How to Avoid Political Discussions with Patients During Examinations

by G. Richard Holt, MD, MSE, MPH, MABE, D Bioethics •

Clinical Scenario

You’re seeing Frank Bell today for a follow-up visit after an initial treatment of acute rhinosinusitis. Mr. Bell is an extrovert with a tendency to express his viewpoints on a wide range of subjects. Today, he seems eager to talk about politics immediately after you greet him.

“So, Doc,” he says, “you’ve got to tell me what you think about (insert any political topic).”

“You look better today than when you came in two weeks ago, Mr. Bell,” you respond. “How are you feeling?”

“Much better. So where do you stand on this craziness? This guy (insert name of politician) is going to run our (insert city, state, country) into the ground. You agree with me, right?”

“Well …”

“You have to see what’s happening here, Doc, right?” Mr. Bell continues. “We have to all stick together against these politicians. I was telling my wife just this morning that if anyone would agree with me on these politicians, it would be you, Doc. Tell me you agree.”

You give a thoughtful pause before saying, “So, has the infection resolved satisfactorily?”

Mr. Bell shakes his head and says, “Doc, I’m not letting you get off that easy. We have to fight this political war together or we all lose.”

You sigh; it’s going to be a long day.

How do you handle the situation without making your patient upset?

Discussion

Effective, appropriate, and respectful communication with our patients is fundamental to the integrity of the patient–physician relationship. As physicians, we are responsible for creating and maintaining the proper atmosphere for bilateral communication, and for directing the conversations toward the necessary clinical goals. Indeed, it’s important for the physician to connect on a personal as well as a professional level with the patient, with the personal interactions directed toward facilitating the professional interactions. A proper greeting, inquiring about a patient’s family and/or job, discussing the weather, asking about social interactions, and so forth are neutral, but important, adjuncts to the professional relationship.

Physicians regularly discuss difficult topics with patients in the course of providing care—end-of-life decision options, sexual activities, drug and substance use, stress in marriage, and a host of other sensitive topics. We don’t shy away from these discussions because they can be difficult or potentially embarrassing; instead, we proceed tactfully and supportively so that decisions can be made and appropriate care can be given. We’re used to engaging patients in stressful and often awkward conversations in the course of our care. It’s part and parcel of what we do.