No Place for Politics

(opinion piece – I’m pretty fired up.)

My exam rooms are sacred. I offer a safe place where the focus is on the patient. I listen, evaluate and hopefully help them on their life journey. What is said in that room is held in the strictest of confidences. I have nursed patients through death, addiction, cancer, births, remission, heartbreak, infections, illnesses and everything in between. They sometimes reveal secrets and body changes that are never otherwise discussed. They can express every emotion, concern, and symptom that they want, knowing that it will not be shared outside of my exam room. That trust helps us collaborate and communicate openly to provide best care.

Patients come to me with a concern then I help them figure out what’s going on and how to optimize their health. Together, we discuss potential options while outlining benefits and risks. That’s it. I don’t track down patients and I can’t force them to do anything they don’t want to do. I typically have a preference, but the choice always belongs to the patient even if it is not what I would recommend first. My job is unique. I’m not here to make the customer happy. As a physician, my job is to provide as much useful information about their health as possible whether they like it or not so they can make the decision for themselves.

Every person’s path is individual and there is rarely an easy answer. Medicine doesn’t work that way (except don’t smoke – it’s bad for everyone). I work in good faith with the probabilities and statistics of science, but I am also continuously surprised by the exceptions of life that I can’t predict. So I am infuriated to find anyone else besides the patient and myself judging best treatment. Social media, headline news, general public, activists, legislators, lobbyists, insurance companies, neighbors, and co-workers are weighing in on things they know little about. What makes their perspective so much more valuable than the patient’s needs? What information do they have that is more reliable than the informed consent from a trained professional? We have all felt the impact of unsolicited advice and like most others, I ignore it and keep working.

You know another cornerstone of my job? Nonmaleficence (aka “do no harm”). If I know I’m not qualified to treat a condition, I don’t do it and I help the patient find a qualified expert. If I think the patient’s choice would break the “do no harm” rule, I decline with no hard feelings and help them find a trained professional for a second opinion. Mutual respect and honest communication about expectations remain essential for the doctor-patient relationship to work. Yes, there are definitely some crummy doctors out there who betray that trust (just like in every other profession on the planet), but all doctors started with the idea of helping others. We were the smart kids. We knew there were easier ways to become affluent or pursue science. The institution of medicine already has oversight capabilities with credentialing committees, insurance companies, state medical licensing, national board certification, continuing education requirements, and litigious patients.

I believe in free speech and the right to express one’s beliefs no matter where they fall on any spectrum. I can still provide good care when they are only opinions. However, I fear the laws being passed that restrict me from providing comprehensive care to my patients. Opinions from nonmedical people are determining patient treatment. Decisions are being made by a public majority dictating what I can say to my patients who need professional medical advice. I resent anyone with no knowledge of the situation who thinks they deserve a vote on how the patient in front of me feels and what their choices should be. And worse, what other restrictions may be placed in the future? These laws will erode the trust and safety of my office putting a barrier in the doctor-patient relationship. As a consequence, serious medical issues and concerns will remain unspoken and unaddressed until something devastating happens. Please let the medical professional organizations judge me. They will also determine appropriate care with well-studied science. These laws determined by nonexperts don’t belong in my sacred room. Believe what you want somewhere else. Get out of my way and let me do my job! My patient’s care has nothing to do with you.

– “It’s a dangerous thing to mistake speaking without thought for speaking the truth.” Benoit Blanc, Glass Onion