Don't let patients bringing politics into the exam room give you a migraine

Contentiousness. Rage. Hate. Political talk often becomes anything but a civil conversation, and these days, patients are bringing their politics with them into exam rooms.

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Although no formal studies have been done, many physicians say political talk from patients is increasing. Vineet Arora, MD, MAPP, associate professor and hospitalist at the University of Chicago, says it’s not just her patients who are talking about politics and bringing it up to her. 

“It came up just recently when I got into a cab,” she says, adding that patients and the public in general especially want to know what physicians are thinking about political issues that relate to healthcare. 

Kevin Pho, MD, an internal medicine physician, physician speaker and coach says physicians are noting this trend both online and in person.

“Unequivocally, yes, patients are bringing up politics more,” Pho says. “The current political situation is not to everyone’s preference, and political conversations are happening more frequently.”

So, should physicians mix patient care with politics? Some physicians work and live in communities that align with their values and politics, but that’s not always the case.

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Josephine Soliz, MD, a primary care physician at the Rose Avenue Family Medical Group in Oxnard, California, says sometimes politics are mentioned in offhand comments, and other times, patients want to engage her in a political discussion.

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“I redirect them mainly because I just want to be sure to cover all of their medical issues,” Soliz says. “I don’t want them to feel like the things they care about don’t matter, but I want to be thorough and not miss things like diabetes.”

Soliz says many political issues matter to her greatly, but she doesn’t talk politics with patients unless they directly bring it up. 

“Sometimes I’ll even say to someone, ‘We could have a great half hour conversation about this because I see it a little differently than you, but maybe we should use this time for your medical concerns,” Soliz says.

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Arora believes strongly that physicians should have their voices out in public discourse, and in fact, she often coaches them on how to best use social media to be active on political issues that affect them. But, she says, it’s important to keep politics out of the exam room. Physicians, she says, are trained to give the exact same care to patients, no matter what the circumstances or personal disagreements they might have with patients.

“You treat the patient in front of you,” Arora says.

If a physician sees a patient with differing political views as adversarial, it could be akin to military doctors who trained to treat enemy soldiers with the same care and respect as they do their comrades. 

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“We’re going to treat both people the same way,” Arora says.  “Doctors are trained to do that regardless.”

When politics comes up, Pho recommends addressing it in a nonpartisan manner. “There are factual ways, for example, to talk about the Affordable Care Act,” he says. “You can talk about things in a factual way without injecting your opinion into it.”

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Soliz says she’s had very opinionated patients say things that could definitely be construed as hurtful or racist. Recently, she had an elderly woman complain about a phlebotomist hurting her, and she referred to the staff person, using her racial identity.

“I addressed it in an indirect way by stating how frustrating it was for her to get a bruise,” Soliz says. “The real problem was a bruised and sore arm, not (the race) of her phlebotomist.”

Soliz points out that in the exam room, physicians and patients are not on equal footing.

“I am very aware of the difference in power in the doctor-patient relationship,” Soliz says. “I would not want a patient to feel they had to conform to my perspective to feel welcome and valued and to receive good care.”

Politics not only is being brought up to physicians, but it’s sometimes being brought up in conversations patients have with other medical staff. Soliz says her medical staff are trained to be courteous, even when dealing with rude patients, and that’s the same way to deal with opposing political views.

“I try not to put down rules for my staff,” Soliz says. “By and large, we leave it to a staff person’s judgment.”

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Politics shouldn’t ever be an issue when patients see physicians, Arora says. “Really, the issue at hand, when you’re treating patients, is not their political view,” she says.  “It’s them.”