Oct. 27, 2008

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A Patient’s Story, a Patient’s Health

Graham Ramsay Lekshmi Santhosh

With fliers of every color fluttering in the wind, exhorting calls to action, educating—and, of course, promising food—Harvard College seems transformed this fall. But on the Longwood campus, you can barely tell that it is an election year. As voices of health reform grow louder on the national stage, advocacy groups, businesses, and pharmaceutical and insurance companies make their opinions clear, but seldom do we hear the perspective of a doctor.

Before you protest that we don’t have time to be physician-politicians like Howard Dean or Bill Frist, recognize that political participation takes a variety of shapes, from keeping up with current events to running for office, and everything in between. Since our nation’s healthcare dysfunctions, disparities, and costs are major issues, physician input into health policy should be crucial: physicians have the unique ability to advocate for patient health and well-being on a scale that extends far beyond the clinic. Policymakers have rarely experienced medicine-on-the-ground, so physicians could provide crucial health policy counsel.

Although our nation’s 800,000 physicians would probably not sway an election’s course, our participation in the political process is crucial to advocate for our “constituents”: our patients. Unfortunately, despite healthcare’s increasing economic and political importance, physicians are often disengaged from politics. Surveys of physician voting behavior and newspaper reading—basic “vital signs” of political participation—show that doctors are less likely than both lawyers and the general population to vote, and we spend less time with the newspaper [Glaser, William A. Doctors and Politics. The American Journal of Sociology, Vol. 66, No. 3. (Nov., 1960), pp. 230-245]. In contrast, over half of our Canadian physician counterparts are either very or somewhat involved in medical politics.

In Washington, the situation is no better. Although healthcare lobbying is the most common form of federal lobbying, pharmaceutical and insurance corporations vastly outnumber physicians, which has grave implications for healthcare reform. And despite our unique ability to educate members of Congress about health issues, we tend not to: only about 50 physicians per state, on average, meet with Congressional health staffers annually. And when doctors do make their voices heard, they nearly exclusively lobby for Medicare reimbursement and managed care reform, while rarely mentioning care for the uninsured, tobacco control, or violence prevention [Landers, S. Sehgal, A. Health Care Lobbying in the United States. Am JMed. 2004;116:474–477]. Doctors don’t lack a receptive ear in government—rather, we seem to miss taking advantage of it. This lack of physician political participation—and the relative inattention to issues of importance—may be creating a vicious cycle in which Congress seeks our opinions less frequently, perhaps leading to even fewer opportunities for us to influence healthcare politics. 

What could explain physicians’ general aversion to politics? Political apathy and mistrust of politicians are reasons that easily come to mind. Two surveys showed that physicians saw themselves as morally superior to politicians, finding that doctors and medical students regard politicians as less intelligent, moral, and dignified than themselves [Glaser (1960)]. Physicians may view political involvement as a time-consuming waste of years of medical training, considering their civic duties satisfied by the daily rituals of clinical medicine, treating one citizen at a time. With few role models, it may be difficult for physicians to start being involved in politics. At most medical schools, training is patient-focused rather than population-focused, with relatively little emphasis on public health or health policy. Doctors may also fear disagreeing with colleagues or taking a stance that could polarize patients. One physician remarked, “Illness is something that transcends political party affiliation. We don’t want to appear biased to our patients.”

Larger historical forces also contribute to physicians’ political disengagement. During the 1960s debates on Medicare, physicians lost credibility in the eyes of the public who saw them as money-mongering preservers of status, rather than advocates for greater access to healthcare [Stevens, R.A. Public Roles for the Medical Profession in the United States: Beyond Theories of Decline and Fall. The Milbank Quarterly, Vol. 79, No. 3. (2001), pp. 327-353]. In 1994, President Clinton’s health plan deliberations barely included physicians ’ input, possibly implying we should have a reduced role in health policymaking.

Doctors, however, have enormous potential to serve as effective advocates for insurance reform, elimination of healthcare disparities, increased biomedical research funding, and other important issues. By advocating for our patients, physicians could restore political legitimacy and refocus attention on healthcare reform. Apathy comes at a serious price: if policymakers removed from medicine-on-the-ground create health policy without consulting doctors, we may end up with a system that leaves physicians and patients alike even more disempowered than we are now.

—Lekshmi Santhosh is a second-year New Pathway medical student at HMS.

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Copyright 2008 by the President and Fellows of Harvard College