For many physicians, discussing political beliefs or controversial advocacy work with patients seems inappropriate or even unethical, though many patients may have no problem with it.
Explore This IssueOctober 2020
Discussing Delicate Subjects
According to the 2018 Medscape Ethics Report, more than 5,200 physicians across more than 29 specialties were divided in their opinion: Forty-three percent advised against discussing political beliefs with patients, 23% said it was fine to have the discussions, and 33% said it depended on a number of factors, such as the state of the physician–patient relationship or whether the patient asked a question.
The American Medical Association has its own code of ethics relating to discussing politics with patients. While acknowledging that physicians enjoy the same privileges of free speech shared by all Americans and noting that it’s commendable for physicians to exercise their political rights as citizens by running for political office or lobbying for political positions, parties, or candidates, the code also states that physicians must be sensitive to the inherent imbalance of power in the patient–physician relationship. Patients may also simply have the desire to maintain their privacy when it comes to sharing their views. Among other things, the AMA recommends that physicians do not initiate political conversations during clinical appointments and don’t allow any political differences they may have with a patient to interfere with delivering professional care.
With the national election season upon us, ENTtoday asked two physicians who write about medical ethics whether or not it would be appropriate to discuss politics or controversial advocacy work with patients. Their answer: It depends on the topic and the tone of the conversation.
When a patient asks their physician a question related to politics, it’s important to take a moment to think before responding right away, according to ENTtoday’s medical ethics columnist G. Richard Holt, MD, D Bioethics, clinical professor of otolaryngology at the Center for Medical Humanities and Ethics at the University of Texas Health Science Center in San Antonio.
“Political discussions can be loaded with significant emotional and personal differences, and the physician should be very circumspect regarding participating in such a discussion with patients,” he said.
While a longstanding relationship with a patient known to be like-minded and with whom the physician shares common viewpoints of an ethical nature may make conversation in these areas possible, Dr. Holt believes it’s usually best to demur and steer the conversation clear of the topic. “In nearly all situations regarding politics, I believe both the patient and the physician are best served in their professional relationship if these topics aren’t discussed, and the physician assumes a neutral pose,” he said.