Iris City Chiropractic Center, P.C.

Robert A. Hayden, D.C., PhD, F.I.C.C. (770) 412-0005

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Doctors and Doctrine: Political Influence in the Exam Room

Robert Hayden, DC, PhD, FICC

Long ago I read a clever quotation attributed by Paul Dixon to the late Sen. Everett Dirksen, labeled “Dirksen’s law,” that said simply “Where you stand depends on where you sit.”  That seems puzzling at first, but Dixon went on to explain that the position you may hold on an issue depends on which side of the aisle you happen to sit, meaning whether you are a Republican or Democrat, conservative or liberal.

In Dirksen’s day, the tone was more civil.  Senators may sit on their side of the aisle and disagree on issues, but after hours you might well find them (over)imbibing in the same bar. We had less abject hatred in those days and fewer liberals shooting conservatives.

Today we are in a completely different environment. Somehow many people began to define those who did not agree with them as “evil.” While this infection festers in the larger society in which we live and the flames are fanned with fake news from committed news media, the effects cannot help but spill out into other facets of life.

All the above leads me to comment on an article I saw in the Proceedings of the National Academy Of Sciences.   It was published a month or less before the 2016 election, so political animus was building daily.  This article suggests that you might be treated differently somehow depending on whether your physician is conservative or liberal.  The premise of this article is that physicians deal with highly charged, emotion driven, politically sensitive issues in health every day. It seems appropriate to the authors that you understand potential nuances in how you might be treated, depending upon where your physician “sits” on the issues.

A representative sample of physicians in this study were matched demographically by age, gender, and religiosity (I have to wonder how the latter was defined), and political affiliation was discovered through voter registration. Each physician was given nine vignettes on which to comment which dealt with marijuana, abortion, exposure to sex workers, and storage of firearms. Answers were compared and correlated by political viewpoint.

Based upon the responses to these vignettes, it was discovered that Democrat physicians tended to see issues related to firearms with great concern.  Republican physicians were more concerned with the issues of abortion and the use of marijuana.  Particularly with reference to abortion and marijuana, Republican and Democrat physicians tended to show similar degrees of polarity irrespective of gender or religion.

The Republican Doctor is more likely to discuss both health and legal risk of marijuana use and urge the patient to cut down or quit. They are more likely to approach abortion from the aspect of the mental health impact on mothers, urging patients not to have abortions.  Both Republican and Democrat physicians shared a very serious perspective on using sex workers, but Republican physicians were more likely to discuss legal risk and the impact on important personal relationships. Democrat physicians were more likely to implore patients to avoid storing firearms at all, while Republican physicians were significantly more likely than Democrats to urge people to store weapons safely.

Both Republican and Democrat physicians are concerned about the use of tobacco and alcohol, while Republican physicians are more likely to favor active treatment. The significant difference is that Republican physicians are far more likely to focus on the use of marijuana with even more vigor than they would focus on cigarettes.

The study mentions that patients are politicized as well.  For example, the Human Rights Campaign, a gay/LBGT advocate group, has compiled a list of gay friendly physicians for referral from that community. The American Association of Pro-Life Obstetricians and Gynecologists also has a referral list.  There are many such advocacy groups that encourage referrals to like-minded health care providers.

The authors of this study conclude that political persuasion of the physician may impact treatment options presented to patients on politically sensitive issues or conditions. If you are a patient, you may want to know the worldview of a physician you consult before you make the appointment.

I find this study interesting in light of the current political environment, but these issues are not new. I will take a moment for a personal observation to make that point.

Several years ago Diane and I knew a couple that eagerly awaited their firstborn child. The child was born with a serious birth defect that resulted in a very short life (a few days). The expense of the birth, radical interventions to prolong life, and the ultimate funeral were only exceeded by the extent of grief for parents and grandparents.

This birth defect was not compatible with life and could have and should have been found by amniocentesis, but the obstetrician was a strong pro-life advocate and the wife of an antiabortion activist. She did not mention amniocentesis to the prospective parents because such knowledge carried the risk that this couple might choose to abort the fetus if it were afflicted, and this position would be untenable for the obstetrician.  Since she did not mention that they should have this test, the worst-case scenario did happen, and this young family was blindsided by something that could have been avoided.  Thus, the political bias of the obstetrician precluded the right of the parents to make a decision, and great harm was done.

In my earliest days of professional education, I came across a doctrine of “radical non-intervention,” which was the notion that we should not impose our political, religious, or personal bias on patients when it comes to informed consent.  We should provide the best and most comprehensive information possible to help people make their decisions. I still think this is a good policy.

What should we take from this study? First and foremost, do your own research as a patient. Know what you want and why. Second, know your doctor as well as you can. You may choose to consult more than one if you are uncertain about something.  Third, speak to your doctor about your concerns and desires. A doctor who does not talk to you openly and honestly may not be the best choice of provider for you, but hopefully he or she went to school so they can help you in this moment of need.