Yes, We Should Talk Politics and Religion With Patients

Cleveland Francis, Jr., MD


September 26, 2022

From our first days as medical students, we are told that politics and religion are topics to be avoided with patients, but I disagree. Knowing more about our patients allows us to deliver better care. I propose that we consider adding politics and religion to our list of risk factors.

Politics and Religion: New Risk Factors

The importance of politics and religion in the health of patients was clearly demonstrated during the COVID pandemic. Lives were needlessly lost because of stands taken based on religious beliefs or a political ideology. Families, friends, and the community at large were impacted.

Over my years of practice, I have found that while these are difficult topics to address, they should not be avoided. Studies have shown that open acknowledgement of religious beliefs can affect both clinical outcomes and well-being. Religion and spirituality are as much a part of our patient's lives as the physical parameters that we measure. To neglect these significant aspects is to miss the very essence of the individual.

I made it a practice to ask patients about their religious beliefs, the extent to which religion shaped their life, and whether they were part of a church community. Knowing this allowed me to separate deep personal belief from stances based on personal freedom, misinformation, conspiracies, and politics.

I found that information about political leanings flowed naturally in discussions with patients as we trusted and respected each other over time. If I approached politics objectively and nonjudgmentally, it generally led to meaningful conversation. This helped me to understand the patient as an individual and informed my diagnosis and treatment plan.

Politics as Stress

For example, on more than one occasion, a patient with atrial fibrillation presented with persistent elevated blood pressure and pulse rate despite adherence to the medical regimen that I had prescribed. After a few minutes of discussion, it was clear that excessive attention to political commentary on TV and social media raised their anxiety and anger level, putting them at greater risk for adverse outcomes. I advised that they refocus their leisure activities rather than change or increase medication.

It is disappointing to see how one of the great scientific advances of our lifetime, vaccination science, has been tarnished because of political or religious ideology and to see the extent to which these beliefs influenced COVID vaccination compliance. As healthcare providers, we must promote information based on the scientific method. If patients challenge us and point out that recommendations based on science seem to change over time, we must explain that science evolves on the basis of new information objectively gathered. We need to find out what information the patient has gotten from the internet, TV, or conspiracy theories and counter this with scientific facts. If we do not discuss religion and politics with our patients along with other risk factors, we may compromise our ability to give them the best advice and treatment.

Our patients have a right to their own spiritual and political ideology. If it differs dramatically from our own, this should not influence our commitment to care for them. But we have an obligation to challenge unfounded beliefs about medicine and counter with scientific facts. There are times when individual freedoms must be secondary to public health. Ultimately, it is up to the patient to choose, but they should not be given a "free pass" on the basis of religion or politics. If I know something is true and I would do it myself or recommend it for my family, I have an obligation to provide this recommendation to my patients.

Religious preference is included in medical records. It is not appropriate to add political preference, but the patient benefits if a long-term care giver knows this information.

During the pandemic, for the first time in my 40+ years of practice, some patients questioned my recommendations and placed equal or greater weight on religion, politics, or conspiracy theories. This continues to be a very real struggle.

Knowing and understanding our patients as individuals is critical to providing optimum care and that means tackling these formally taboo topics. If having a potentially uncomfortable conversation with patients allows us to save one life, it is worth it.

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About Dr Cleve Francis
Cleveland Francis, Jr., MD, Diversity, Equity and Inclusion Advisor; Inova Heart and Vascular Institute (IHVI), Falls Church, Virginia; Former president and founder, Mount Vernon Cardiology Associates; Chair, IHVI Committee on Equity, Healthcare Disparities, Education and Outreach; Member, Inova Inclusion Counsel

Dr Francis is also a songwriter and performer. He is a former recording artist on the Capitol Nashville Country Music Label (1992-1995), and his music has been featured at the National Museum of African American History and Culture in Washington, DC.

Connect with him:
Twitter: @muzicdoc2
Facebook: Cleve Francis
Instagram: @muzidoc


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