Doctor's Dilemma: Is It My Duty To Get Political Or Stay Out Of The Fray?

When I was 17 years old, I insisted that my father, a pulmonologist, join Physicians for Social Responsibility. I had just read about the organization in my history class, and I was feeling increasingly hopeless that I would live to see my 30s if the world continued its march toward nuclear Armageddon.

My father refused to even have the discussion.

I’ll get to why he refused in a minute, but first, a bit of context. It was 1984. I had heard the famous gaffe by then-President Reagan about the bombs that would start falling on the Soviet Union. I had watched my hometown of Kansas City get quite literally nuked into oblivion in the made-for-TV movie “The Day After.”

And, at the time that I confronted my father, I was also busy trying to procure a last-minute date for the prom, as my girlfriend had unceremoniously dumped me a mere three weeks before the dance. In other words, I was itching for a fight.

I marched home that day, emboldened by my righteous indignation that there existed an organization of physicians devoted to saving us all from the end of the world and my father was almost certainly not a member.

“Dad,” I said, “Have you heard of Physicians for Social Responsibility?”

My dad worked long hours, and he was largely apolitical. As a doctor, he was old school. Medicine for him was a calling with a capital “C,” empathic care mixed seamlessly with Rockwellian paternalism. He had a tacit agreement with the people whose emphysema and cancer he made better: He would tell them what to do medically, and they would more or less do what he said. In exchange, politics and ideology were checked at the door.

That very year, I had watched the president of our student body present Reagan with a giant pencil when he visited a local high school. We were not allowed to ask questions of the president, and this inability to query my political leader sharpened my sense of uncomfortable impotence. Someone had to stop the end of the world.

My father sighed, sensing the quarrel that was about to break like a Midwestern thunderstorm.

“No, Steve, I haven’t. Can I at least get undressed?” He loosened his tie and sipped gratefully from the glass of scotch that he had poured for himself as soon as he'd walked in the door.

“Dad, nuclear war is a medical concern, and you have to speak up!” (This was essentially the tagline for Physicians for Social Responsibility.)

“I’m not going to join, Steve.”

My father took off his dark socks, one at a time.

“But why not?”

“Because my patients need me, Steve. I was trained to let them need me. If they think that I don’t agree with their politics, they might not do as I ask. That’s not my place.”

I was predictably livid.

“Don’t you think the end of the world trumps what your stupid patients might think?”

I thought I had him now, back against the ideological ropes.

“No,” he sighed. “I don’t. If you become a doctor some day, you might think differently, but I am not going to let my patients know my political opinions.”

And that was that. No grand showdown. When my dad didn’t raise his voice, I knew that the argument just wasn’t going to happen.

Now, more than 30 years later, I find myself struggling with whether I ought to embrace the same stance as my father.

Do I weigh in with gusto on my sense of the disaster that this election could possibly engender? And do I do it from my bully pulpit -- however humble that pulpit might be -- of having taken an oath to practice medicine?

Most importantly, what if my father was right? What if the practice of medicine is incompatible with publicly stated political convictions?

I’ve talked to many physicians on this subject, and — as anyone who has ever talked to many physicians might expect — there are widely differing opinions.

Pros And Cons

In psychiatry, my field, we are often coached to leave all of our personal lives out of the office, at least in some venues. No pictures of our children on our desks. Some even eschew the diploma. Although we recognize that no one can be entirely free of assumptions, we’d like our patients to feel safe with whatever opinions they’d like express. This is of course not entirely possible. Patients often read all about their doctors through on-line investigations. I've certainly read about mine. But attempting this level is anonymity is still a far cry from handing out political flyers in your office (something one doctor I know has done), or actively campaigning for a political cause.

Then there’s the public health argument. Physicians are often called on to comment on which environmental circumstances are best suited for wellness. This was essentially the rationale for the creation of Physicians for Social Responsibility.

And finally, there are the extreme examples. What if a candidate or a political movement seems so fraught with danger that any individual, physician or not, could later deeply regret keeping silent instead of protesting?

To my mind, here's the crux of the question: When a doctor is home from work and no longer seeing patients, does that doctor cease to be a doctor? Can a doctor state, with polemic impunity, that he or she is speaking now only as a citizen, absent the training and the responsibility that encompass the role of the physician?

My father thought not. He wasn’t alone in this conviction, either, and many argue that my father’s stance is still the most appropriate.

Some researchers have suggested that whereas doctors were highly involved in earlier political movements, such as labor rights and better access to health care, the trust in physicians has eroded as public doubts have risen about the profession's unfettered altruism. Speaking out politically could further erode that trust.

Some have argued, as well, that serving both social concerns and individual patients necessarily puts one cause in conflict with another. This view, however, also has its vehement detractors.

I find this lack of consensus extremely comforting. It provides cover for me to decide outside of the rigid guidelines to which my father adhered. In other words, some believe that physicians can be politically active and some do not. Very bright people of conscience hold opposing views on the question. This affords me freedom within the standards of my profession to decide for myself what to do.

So I've Decided.... 

• I will not stay entirely silent. I find this election genuinely more troubling than any I have seen before. This is my nation and I will express, openly, my opinions in the public sphere. If people choose to hear these as my personal opinions, or the opinions of a physician, or both, that’s fine. If I happen to know something from my training that makes clear the reasons for my convictions, I will use that information. Gun control and the risk of suicide are perfect examples of my professional knowledge and my political opinions aligning.

• I believe that by expressing my views with civil respect for those who might not agree, I can, both wittingly and through example, remind myself and hopefully others that this nation is built on the scaffolding of disagreement and compromise.

• To that end, the search for common ground in the political sphere is extremely similar to the search for common ground in the doctor-patient encounter. Most doctors will work hard to find that area where clinician and patient agree. This helps to elucidate what will work for the patient, and to identify pockets of resistance to medical recommendations. That sounds an awful lot like the political give and take on which our country runs best.

As for my actual opinions? That’s the subject of another piece. But you should know that I shared these thoughts with my father and I found that he had mellowed a bit over the last three decades.

But “be careful,” he said. “Your patients come first.”

And of course he’s right.

Dr. Steve Schlozman is associate director of the MGH Clay Center for Young Healthy Minds. He's also assistant professor of psychiatry at Harvard Medical School. He tweets @SSchlozman.