How to Avoid Political Discussions with Patients During Examinations

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

Friendliness is very important, but maintaining a professional relationship is fundamental and required.

In Great Britain, healthcare policy is national politics. An individual physician’s role in health policy is basically to understand it, to explain it to patients, and to advocate for patients. If patients ask for or require explanation of health benefits and regulations, this assistance can be given to them.

To some extent, the United States may be evolving in the same way. During the current pandemic, physicians have needed to spend substantial time helping patients understand the difficulties of providing and receiving healthcare within the constraints imposed. It isn’t inappropriate to take time to explain the importance of public health policies under effect (mask wearing and social distancing) and to discuss the risks and benefits of vaccinations given a patient’s particular health status. If patients wish to debate the politics of healthcare policies, however, a venue other than the examination room is more appropriate. Above all, the patient’s health issues are paramount, and with limited time allotted for evaluation, discussion, and treatment during a visit, discussing politics is rarely worth the distraction.

My wife, an experienced senior physician with a geriatric population in the majority, has the knack of moving past controversial topics. She has developed some very effective skills to respectfully deflect or contain a patient’s interest in talking politics. Her responses before moving on to the history and examination include:

  • “Yes, our country is certainly facing a lot of challenges, but we’ll make it through just fine.”
  • “Just stay informed and know the science.”
  • “We have to stick together during this time of trouble and uncertainty.” 

Each of us must develop the mechanisms to cope effectively and respectfully with political issues in the examination room. In my opinion, physicians shouldn’t impose our political views on patients. A political discussion with patients fulfills no ethical requirement or responsibility and could, in fact, be an ethical breach of duty.

In the clinical scenario, the physician is faced with a patient who seems determined, although friendly in his efforts, to engage in a political discussion. The physician needs to respectfully deflect and redirect the conversation to the matters at hand, namely the patient’s health issues. Using my wife’s successful model, it might be appropriate to counter with, “I can see this is a topic of interest to you, but here today my main focus is on you and your health, so let’s move ahead with the examination to see how you’re doing.” Moving the focus back to the patient will hopefully demonstrate that his health is more important to you than the health of the political climate.