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02/12/2014

Take Two Aspirin and Let Me Tell You What I Think About the Affordable Care Act

by Kayhan Parsi, JD, PhD

I recently saw a subspecialist for a medical procedure.  I had never met this physician before so as he sat down to review what was going on in the monitor in front of him, the first thing he asked me was what I did for a living.  I promptly informed him that I was a bioethics professor at Loyola University Chicago.  This immediately piqued his interest.  He asked me what this entailed, and I told him that I taught graduate and medical students, did ethics consultations, did my own research and writing, gave presentations, etc.  When I told him about the big topics of our field (e.g. end of life care, genetics, health care reform), he quickly informed me that he had opinions on all of these matters.  Uh, oh, I thought, I’m going to get an earful from this physician opining on a number of issues.  And, true to form, he did have strong views about medical malpractice (natch), end of life care, and of course the Affordable Care Act.  He felt strongly about the overuse of resources at the end of life and was deeply troubled by the threat of lawsuits in medicine.  We even discussed the exorbitant amount of debt medical students incur after four years of medical school.

To be fair, he probably believed that because of my profession, I opened the door to discussing all of these issues with him.  I tried to deflect or redirect most of his questions, and even told him that he should run for public office.  Although the word “awkwaaard” did pop into my head, I also was intrigued by this physician’s insistence on discussing highly controversial topics with me.  Here I am doing a highly specialized procedure and my physician wants to talk about politics and ethics (fortunately he didn’t want to talk about sex and religion too).

I shared this story with my wife and some colleagues, laughing about its Seinfeldian overtones.  Although I didn’t have a problem with the physician’s technical acumen, I did leave reflecting on his judgment.  What would possess a physician to launch into a diatribe about the Affordable Care Act when treating a patient?  A charitable view would be that this physician rarely treats a patient who is an ethicist and has some knowledge on these topics.  But, it also reminded me of a relevant opinion of the AMA’s Code of Medical Ethics.  Opinion 9.012 states the following:  “communications by telephone or other modalities with patients and their families about political matters must be conducted with the utmost sensitivity to patients’ vulnerability and desire for privacy. Conversations about political matters are not appropriate at times when patients or families are emotionally pressured by significant medical circumstances.”

My take on this opinion is that it’s perfectly acceptable for physicians to express their political views when invited by their patients.  A 2006 study suggests that most primary care physicians do discuss political health care issues with their patients and a slight majority even initiate them.  Moreover, I have physician colleagues who inform me that their patients will ask them directly about their views on such matters as the Affordable Care Act.  The opinion I cited actually lauds physicians for being politically active and we see countless examples of physicians who are active in political campaigns or participate in activist organizations (e.g., Physicians for a National Health Program).   However, when uninvited by the patient, a physician volunteering his or her political views on sensitive matters may be uncomfortable at best or, at worst, even inappropriate.  Sharing strongly held views with one’s patient when not initiated by the patient re-focuses the attention on the physician, not the patient.  In the age of social media, the lines between our professional and personal identities are increasingly blurred.  In the exam room, however, a physician should take the lead from their patients regarding political issues in health care.  If the patient initiates the discussion, then by all means engage.  However, if the patient seems uncomfortable with this kind of discussion, best to tread lightly.

This entry was posted in Clinical Ethics, Featured Posts, Health Care, Politics, Privacy and tagged . Posted by Kayhan Parsi. Bookmark the permalink.

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