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Monday Nov 05, 2018

Should We Talk Politics With Patients?

Growing up, I never viewed my father as someone who regulated or dominated the household; rather, he dispensed fatherly advice, kept us honest and was a steady presence in our lives. He had one rule, though, and on this he never wavered: No political conversations at the dinner table.

[red and blue strings pulling on stethoscope]

"No politics!" he would interrupt when the conversation landed on a particularly juicy, hot-button policy issue. "Gotta change the subject."

Talk would then have to turn to school, soccer or whatever else was going on in our lives. On this point he was resolute.

My parents would regularly watch electoral debates, and the State of the Union was essential January viewing, but to my father, these events were information-gathering only; he would always keep his political opinions private. To this day, I don't know if he voted for Clinton, Bush or Perot in 1992.

As a young adult, I always felt conflicted about the idea of brushing potentially prickly policy discussions aside. My high school friends and I were from a generation that learned to question the appropriateness of rules in a civil manner. Learning about communism in post-Cold War America presented an objective opportunity to identify the socioeconomic effects of imposing certain rules of order. History lessons on McCarthyism, the Vietnam War and the civil rights movement taught us humility when it came to the "rightness" of our own government in relatively recent history and reinforced the complexity of political decision-making.

I was also strongly influenced my mother's side of the family, which included a group of independent-minded professional women who placed a priority on the importance of education and who taught me to be discerning and stand up against injustice.

My parents nurtured some amazing friendships with their own peers, who I now know to be of differing political persuasions. I can't help but wonder if my father's One Rule was an important guiding principle that liberated evening discussions from the weight of the world at large.

As a young family physician working in a federally qualified health center for more than seven years, first as a resident and now as a full-time practitioner, I encounter signs and symptoms of injustice daily. At many patient visits, I identify theoretical opportunities to manage the chronic conditions of inequity and poverty through policy change. Working with a largely underserved population constantly energizes me to advocate on my patients' behalf.

But how should we as family doctors deal with politics in the exam room? In the office with our staff? When my "Who is the president?" orientation question during hospital rounds turns into a political rant by my patient?

Political inquiries pop up at predictable intervals, such as when seeing patients who lack insurance, or they burst forth like an unexpected jack-in-the-box when I ask whether there are guns in the home.

These days, when hospital patients have access to 24-hour news channels, and clinic patients are engaged in current affairs via their smartphones when I walk in the door, I find myself struggling with how to deal with politics as a doctor more than I ever expected. I wrestle with whether and how to respond to policy issues that worm their way into a patient's history of present illness while I'm diligently trying to go about my primary job of being a healer.

Sometimes, it seems, healing can only be accomplished by facing the policy issue head on: "You, my friend, may not be able to get the subspecialty consultation you need unless our state expands Medicaid." This kind of situation drives me to write op-eds for the local newspaper(billingsgazette.com) and regularly meet with my state and federal legislators.

But most times, it is not that simple. Frequently, it is like dealing with the proverbial hand-on-the-doorknob question: "Doc, let me ask, what do you think about Obamacare?"

This is a critical moment. At times like this, the "mother's side" of me feels an urge to educate and engage in civil discourse, but that is tempered by the angel of my father on my shoulder. The piece of my medical school training that emphasized open-ended questions meets head on that part of my residency training where I learned to nurture the doctor-patient or doctor-staff member relationship.

Whether it's the best approach or not, so far, I've chosen to individualize these political curveball questions. "Tell me more about why you ask," I'll sometimes say. "There are definitely some of my patients who benefit, but it's a complex issue. And we've only got 15 minutes together," I'll say at other times.

If the reason for the question seems to be genuine interest, I strive to educate the person with what I know. But if it's a way to vent or to gauge my political affiliation, I tactfully acknowledge the topic and then steer the conversation away, as my father would do.

This election week, I think we can all learn a little bit from my father. Sometimes it is enough just to be a steady presence in the lives of our patients and co-workers.

Chris Baumert, M.D., is a family physician at a federally qualified health center in Billings, Mont. He also teaches at the family medicine residency based there. You can follow him on Twitter @cbaummd.(twitter.com)

Posted at 01:08PM Nov 05, 2018 by Chris Baumert, M.D.

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