Hostility in Your Medical Office: Are Politics to Blame?

Neil Chesanow

Disclosures

July 12, 2017

In This Article

The Itch That Must Be Scratched

Talking politics in these highly partisan times can be a ticking time bomb. Things can easily get out of hand. Voices can grow loud. Faces can turn red. Tempers can flare. It can disrupt your practice.

That's why many experts recommend that talking politics be off limits in the office. But it's easier said than done. Political expression is an itch that begs to be scratched. And that itch is intensified by the seemingly unending drama of breaking news that shows up in the morning papers and becomes fodder for office gossip around the coffee machine at 9 am.

Medical historian Thomas Stewart Huddle, MD, PhD, professor of medicine at the University of Alabama at Birmingham, believes that talking politics is impossible to avoid, particularly for physicians. "As the conditions of healthcare seem increasingly a product of the political process, and all of our lives are affected by political outcomes, how can we not be talking about that?" he says.

"It seems to me a very natural thing that we should all be more politically conscious of and sensitive to how the government is affecting our practices and our professional lives," Dr Huddle maintains.

"We live in a time of great political polarization," Dr Huddle adds. "It harks back to the early '70s, when the polarization over the Vietnam War was at its height, and political discussion was often conducted in very bitter and rancorous ways. It seems like we've come to a similar moment now, which makes political discussion very fraught and difficult. Should we do it? I don't think we can help but do it. But we need to figure out a way for it to happen productively rather than simply having a shouting match."

The potential for shouting matches, even among physicians, who are generally in control of their emotions, certainly exists. Doctors are deeply divided politically, says Dr Dhruv Khullar, an internal medicine resident at Massachusetts General Hospital and Harvard Medical School, whose thoughtful essays on doctors and medicine have appeared in the New York Times and other publications.

Dr Khullar notes that doctors' political affiliations tend to sort along demographic lines, with men, higher-paid specialists, and older doctors generally identifying as Republican and women, lower-paid specialists, and younger doctors tending to lean Democratic.

Last year, Medscape reported that most infectious disease specialists (77%), psychiatrists (76%), pediatricians (68%), and geriatricians (63%) were Democrats, and most surgeons (67%), anesthesiologists (65%), urologists (62%), and ears/nose/throat specialists (61%) were Republicans, based on unpublished data originally reported in the New York Times.[1]

"Especially in today's political climate, it's very difficult to completely avoid discussion of politics," Dr Khullar observes. "It's something that is always in your face. It's always on the news. People are always concerned with what's going on or what's not going on. It's certainly something that I've noticed here at Mass General and at Harvard and in Boston more broadly—that people are much more activated, much more interested in talking and engaging with these issues. And it's something that we see a lot more of between doctors; doctors, nurses and other medical providers; and doctors and patients."

Are doctors and their coworkers, even when they hold sharply opposing views, able to maintain an amicable modus vivendi in the interest of collegiality, if not friendship? Or are these exchanges heatedly partisan?

To get a sense of what is going on, Medscape asked several doctors in different practice environments in different parts of the country whether talking politics took place in the workplace and, if so, how it tended to play out.

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