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October 25, 2018

'Take two aspirin, and I’ll see you at the polls': Is it ever appropriate for doctors to tell their patients to vote?

Daily Briefing

    "[I]s it time for doctors to pull out their prescription pads and … start prescribing democracy?" That's the controversial idea put forth by physician Danielle Ofri in a recent New York Times opinion piece—but her proposal has drawn pushback from both sides of the aisle.

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    Physician says docs should encourage patients to vote

    In the Times, Ofri, a physician at Bellevue Hospital and professor at NYU Medical School, writes that while doctors "typically offer sympathy" to patients who say "they can't afford their medicine, fear being bankrupted by medical bills, or struggle to find treatment for an addiction," it might also be a physician's "responsibility to point out that these problems are not just bad luck, but also the result of political decisions." Ofri posits, "In addition to our medical counsel, perhaps we should also encourage them to vote."

    Ofri writes, "Like many doctors and nurses, I became politically active for the first time during the summer of 2017, when Congress tried to repeal the Affordable Care Act [ACA]. I could see the direct risk to my patients—all of whom, inconveniently, had pre-existing conditions—and realized that protecting health care coverage was as critical as prescribing insulin."

    She explains, "Political decisions that affect insurance coverage, access to medical care, housing, minimum wage, immigration law, water sources—just to name a few examples—exert medical effects that are comparable with those of major diseases. Just ask the people of Flint, Mich[igan]."

    While Ofri acknowledged that encouraging patients to vote might seem "like a radical extension of the medical mandate," she argues it is not too far outside of the medical purview. "Just as hospitals and clinics help the uninsured obtain coverage, they should also help eligible voters register," she writes. "Waiting rooms are filled with brochures—there's no reason voter registration materials can't be in the mix."

    And this, Ofri writes should be done without individual physicians "advocating political viewpoints in the exam room." She continues, "[P]atients need a neutral, nonjudgmental atmosphere to feel secure." She concludes, "When our patients ask what they can do to improve their health, in addition to sunscreen, exercise, and five servings of fruits and vegetables, we should advise voting."

    Others say politics have no place in clinical settings

    But not everyone agrees with Ofri.

    Writing in the National Review, Wesley Smith—a lawyer, author, and senior fellow at the Discovery Institute's Center on Human Exceptionalism—writes that physicians should not bring up politics in the clinical setting because such conversations are likely to be partisan, with physicians advocating for a particular political agenda.

    Citing Ofri's opinion piece, Smith writes, "Considering the repeated examples she gives of the political issues doctors should address with patients—and the apparent approach she believes they should promote—does anyone believe her disclaimer that 'viewpoints' would not be advocated in the exam room? I don't. And frankly, neither does she."

    In addition, Smith argues that patients visiting the doctor likely are sick, and "[t]he last thing sick people need while being admitted to a hospital is a nurse or clerk trying to get out the vote." Smith adds, "I don't want to be harangued by my doctor about politics during a physical. I don't want my doctor asking me if I have guns or preaching to me about firearms policy (as some have urged they do). I don't want to hear my doctor pontificating about the [ACA] or what our public policy should be about the opioid epidemic—all of which would happen inevitably once politics entered the exam or treatment room."

    From the other side of the political spectrum, Kevin Drum, a writer for the left-leaning magazine Mother Jones, argues that physicians should not bring up politics when seeing patients because it could negatively affect the doctor-patient relationship and erode trust.

    "If doctors are increasingly viewed as political actors, it will affect their authority on genuinely medical issues," Drum writes. He asks, "If your doctor insists that you should get out and vote to save Obamacare, for example, what are you going to think when she also insists that you should get the full course of vaccines for your new baby?"

    Drum concludes, "Bottom line: think about how this plays out over the long term. It might seem like the right answer for an individual patient, but for the profession as a whole it isn't" (Ofri, New York Times, 10/20; Smith, National Review, 10/22; Drum, Mother Jones, 10/22).

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