March 23, 2017

Professionalism, Politics, and a More Perfect Union

Professionalism, Politics, and a More Perfect Union

One day after the election, a fog descended. My body operated on rote. In the morning, my legs carried me past sullen shadows through a city painted in gray scale, and in the hospital, my hands were choreographed by some unseen puppeteer. My colleagues wore painfully familiar faces of austerity and defeat. I gave my friend a long hug, and we departed without saying a word.

This is one experience of the election. A mere thirty minutes away, the scene is completely reversed.

On November 8, 2016, our nation’s 58th presidential election exposed an uncomfortable but incontrovertible truth: our most fundamental values of equality, justice, and prosperity mean entirely different things to different parts of this country. Within the politically homogenous bubble of my immediate medical community, friends and colleagues met this news with unrestrained anguish and genuine fear, particularly if they were minority, Muslim, immigrant, or LGBT. Women who expected the glass ceiling to be broken were forced to conclude that this was a repudiation of their gender. There was shock, outrage, and expletives, followed by calls to honor democratic ideals and moral principles, followed by more outrage asserting the prerogative to express emotion. “Never have I felt so hated in this country,” wrote one. “This is the America we deserve,” proclaimed another. Judging by the political discussions since, the future of reproductive rights, the Affordable Care Act, and stem cell research remains entirely in question.

I am learning to process these emotions in the context of this profession. In my training thus far, I’ve been taught that there is no right way to process emotion; a patient given bad news may cry, laugh, become angry or despondent – all of which are legitimate and valued responses to be acknowledged by their physician. In the same way, these visceral reactions – whether characterized by despair or jubilee – are equally valid, and deserve the empathy that is afforded to each emotion.

The greater challenge, however, is learning to cope with different beliefs. These beliefs may be entirely antithetical to one’s identity or ethics, and those that carry these beliefs may be patients or colleagues in which our professionalism (if not our humanism) requires us to abide. No longer relegated to the purview of political scientists, the question of how to live amiably in a deeply divided and pluralistic society pervades the collective consciousness of this generation. Too often have I seen students, patients, and professors openly or clandestinely ostracized for holding minority viewpoints; too often have I experienced this myself. There should never be room for hate, but this also means that even some beliefs antithetical to a particular race, sexual orientation, or gender may be epistemologically sound – and there should be room for its expression, without condemnation.

On family medicine, I rotated through a clinic near Fayetteville, NC, where many political rallies were held. As with my preceptor, I was loath to discuss politics, but from time to time, my patients confronted me directly about my political views. Generally, the decorum for political discussions in the clinic is the same as any discussion on politics among strangers: say something generic, mention how politics as a whole is terrible, and try to avoid controversy while smiling and nodding. This time, however, patients invited discussion by wearing their politics on their sleeve (sometimes literally), and several times I eschewed decorum to inquire about their beliefs. With surprising candor, I learned that their deepest grievances were health-related – particularly about rising healthcare premiums and pro-choice Supreme Court decisions – and in the process of this inquiry, I learned more about the community than any reading could teach me. Though possible solutions to these issues are indeed political, the grievances that many patients feel are not. By attempting to understand people, what they cared about, and what they were afraid of, opportunities for frank conversation were created that enhanced patient trust. As an outstanding example, a patient who had been refusing to take medications for fear of side effects agreed to try after our conversation, citing that I had valued his perspective. In a time when most of the country is shouting past each other, and faith in established institutions is low1, don’t patients deserve the opportunity to be heard this way?

I’m learning. Perhaps the key is aiming for understanding, and not to take a side – which is easier said than done, but can be achieved with relative ease due to the temporal nature of patient interactions. However, in schools or workplaces where political discussions abound, the stifling of minority viewpoints (whether consciously or unconsciously) often occurs because the prevailing wisdom is that it is easier to work with people in whose opinions you do not know rather than with people you actively disagree with. This classic error is associated with adopting more extreme attitudes over time2, and without active prevention of these situations, I believe we are denying ourselves the extraordinary opportunity to embrace disagreement.

History provides an inspiring example. Fifty years ago, when Martin Luther King, Jr. marched on Chicago for open housing, leaders of the American Nazi Party, the anti-black, anti-Semitic National States Rights party, and the Ku Klux Klan, gathered in counter-protest with thousands of followers. King, who had been struck in the head by a stone only a few days earlier, marched through an all-white neighborhood while being pelted with “rocks, bricks, bottles, beer cans, apples, and firecrackers”3. At a critical juncture, he approached a group of 100 angry teenaged youths, and said, “You are all good looking and intelligent. Where did all that hate come from?”4

King knew, as we know now, that we must learn to live with people who disagree with us on fundamental things. Medicine has an astonishing ability to be apolitical, and too often we are afraid to make our deeply held personal beliefs known for fear of offending someone or being perceived differently. Instead, if this election taught us anything, we should not be afraid to say what we believe and still be accepting of people who believe differently.

Inviting and challenging the varied perspectives of our colleagues should be part of our medical training, as it remains a potential solution to our moral inarticulateness. Germane to both the immediate aftermath of this election and to the future, deliberate, regular, and sustained engagement in divisive issues prepares us to confront the growing salvo of post-factual or over-politicized health-related discourses, ranging from vaccinations, abortion, and universal healthcare, to homeopathy and physician-assisted suicide. We will undoubtedly talk to patients about one or more of these issues, and we must learn to do so with a respect that supersedes our views.

If this can be a microcosm of our nation moving forward, I would urge, in this moment of national self-reflection, the humility of asking our colleagues for their perspectives, and to consider, for a moment, your own to be subject to error and change. This is the hard work of democracy, of day 1 after the election, the rare window of opportunity for us to forge a more perfect union.

  1. Gallup. Confidence in Institutions. 2016. Available at: http://www.gallup.com/poll/1597/confidence-institutions.aspx.
  2. Stroud NJ. Media Use and Political Predispositions: Revisiting the Concept of Selective Exposure. Polit Behav. 2008;30(3):341-366. doi:10.1007/s11109-007-9050-9.
  3. Janson D. Dr. King and 500 Jeered In 5-Mile Chicago March. New York Times. http://query.nytimes.com/mem/archive/pdf?res=9F0CE1D8143BE53BBC4A51DFBE66838D679EDE. Published August 22, 1966.
  4. Ralph JR. Northern Protest: Martin Luther King, Jr., Chicago, and the Civil Rights Movement. Harvard University Press; 1993.

Jerry Lee is an 3rd year medical student who hates politics but loves kale.