Should doctors stay out of politics?
Or is that even possible?
Welcome to Chief Complaint! For those of you who are new, this newsletter features intermittent musings about medicine, gender, parenting, and body liberation — all from your friendly neighborhood primary care doc. I’m so happy you’re here.
In the mail the other day, I received a badge from an organization called Vot-ER. I had ordered it a few weeks ago, to wear at work seeing patients. It looks like this:
I love talking to my patients about voting. I’m a people person, and I just adore chatting with my patients about all sorts of stuff going on in their lives. In fact, I wish I had more time for chit chat. It’s one of the many reasons I wish I had longer than 15 minute appointments with my patients.
I am impressed with the work Vot-ER is doing, giving health care workers the tools and skills they need to encourage their patients to vote. This is their mission: “Vot-ER is revolutionizing voter engagement by transforming routine healthcare visits into opportunities for civic empowerment, partnering with trusted health professionals, and reaching historically underrepresented communities.”
There’s something about that vision that really resonates with me. A primary care visit is one of the few times I engage deeply and intimately with people who are different from me.
It’s more serious than a chat with a neighbor or in a grocery store. (Although that can be a great moment to chat about voting, too!) It’s (usually) more welcome than a knock on the door or one of those poor volunteers who tries to flag you down when you’re walking down the street.
I work hard to earn my patients’ trust. So when I bring up voting, I hope it comes across as something important; something that has a real, lasting effect on patients’ lives. Our political culture has a profound effect on the way my patients access and experience medicine. A discussion about voting feels natural.
I had a student working with me in clinic during one of these recent conversations. A patient complained about the rising price of insulin, and I said, “You know, prescription drug costs are a big election issue. Are you registered to vote?”
The patient told me she had stopped voting after a bad experience many years ago, when she felt like a poll worker pressured her into voting for a particular candidate. I told her how sorry I was to hear that, and that this time around she’d be better prepared to use the voting equipment without interference from any volunteers.
“Just Google the words ‘Register to vote, New Jersey,’ and you’ll find all the info you need,” I told her.
After the patient left, the student I was working with that day turned to me. “That was an awesome conversation,” she said. She paused. “But do you ever worry that patients feel pressured to vote for a certain candidate? That they feel… Coerced?”
This, my friends, is why I love working with medical students. Dang, they keep me on my toes!
I take my student’s concerns very seriously, and I think she brings up an important point. I love talking with my patients about their lives beyond their medical diagnoses, and I love talking politics.
But is that okay in the exam room? Where should I draw the line?
I’ll start by noting that I have never, ever, ever told a patient to vote for a particular candidate.
I have had patients ask me whom I’m voting for, which usually goes something like this:
Me: So, you’re registered to vote, right?
Patient: Yep! I always vote. Who are you voting for, doc?
Me: Oh, you know that doesn’t matter. I wouldn’t ever tell you to vote for anyone in particular, just that you vote in general.
Patient: Oh come on. I bet I know who you’re voting for.
Me: I think you can probably guess…
Patient: Just tell me!
Me: *Shrugs*
I have, with enough prodding, made it clear whom I’m voting for in a given election. It’s usually the same candidates my patients are supporting, although not always. But it’s not information I readily disclose. (Interestingly, I also don’t vote in the state where I practice medicine, so while I have plenty of opinions on New Jersey politics, I don’t have much of a say in them.)
I do, however, share some opinions on political issues as they intersect with health care. This is usually obvious in the way I practice medicine.
I provide gender-affirming care for transgender patients, for example, an issue that has become politicized and even criminalized in some states. I don’t tell my patients who to vote for, but I do show them with my actions that I believe this care should be legal, safe, and widely accessible.
I provide medication-assisted treatment for patients with opioid use disorder, another issue that’s quite hot-button in local Philadelphia-area politics. (See here, for example, about how our mayor addressed an encampment of people experiencing homelessness and addiction.) I am proud to be able to provide addiction care in my primary care clinic right alongside well-child visits and visits for high blood pressure, not at a specialized addiction clinic that might be stigmatized and difficult to access. I think my politics on this issue are made clear by my actions. But still, I’d never tell a patient to vote for a particular mayoral candidate, even if I’d tell them how passionate I am about needle exchanges and federal policy that opens up doors to widespread treatment access.
The personal is political, and medicine if nothing if not personal. Politics is deeply, deeply intertwined with every aspect of medical care, from the fact that our visits are only 15 minutes long, to the difficulty I have accessing a patient’s electronic medical records from another hospital, to the fact that insulin prices continue to skyrocket for a medication that’s been off-patent for decades.
Still, doesn’t something feel different about openly endorsing a presidential candidate in my conversations with patients? Politics affects their care, and politics are driven by candidates. But that’s a line I rarely cross.
Ultimately, I don’t think it does much good for me to bring up specific candidates, and it has a lot of potential to do harm. It can alienate my patients and drive a wedge between us, in ways that aren’t relevant to their medical care.
You betcha I’ll be talking to my patients about registering and planning to vote, though.
I’m curious: What role, if any, do you think politics plays in the physician-patient relationship? Would you be thrilled to talk about voting with your doctor, or is your voting plan none of their business? Where do you draw the line between civic engagement and coercive pressure?
I have patients ask me about politics occasionally, some to get a rise out of me, others to bond because it is pretty obvious we are if like mind. And then there are the ones who do want to have a conversation. I am not as comfortable chatting with those that I know don’t see the issues the same, but I do try to give them my perspective as a doctor doing her best patients. Thanks for a great article.
I wouldn't be opposed to talking about voting in this context, although I *would* be surprised to have a doctor bring it up. I don't think I'd feel the conversation was meaningful, largely because that 15-minute limit, for me, precludes feeling any sense of actual safety and connection.
One thing I wish doctors would talk about *more* is policy related to medical care. I'm fascinated by that kind of conversation, and I love to have access to discussion partners who have both direct expertise and skin in the game. I learn so much that way. Again though with that 15-minute limit being a major blocker to deep conversation.