This post was written with discursive intent, not to enforce my personal ideologies ( which in themselves are liable to frequent alteration) or to represent the views of medical professionals.
Recently my personal research has been directed towards healthcare advocacy for disenfranchised groups in society. This has prompted me, time and time again, to probe my own politics. I define politics, as I am to use it in this post, as a person’s opinion of how government should occur ( not in the sense of ‘politic-ing’ which is the action of navigating power structures to influence government). This post will be an accumulation of conversations and thoughts I’ve had regarding this issue.*
‘Being political’, what does that mean? This is very subjective and will vary depending on who you talk to. Some may say it is having an opinion on how government should occur (on a larger societal level or a smaller communal or even domestic one). Following this definition everyone has elements of political thought: as a human being it is extremely difficult to be apolitical. However for others ‘being political’, is synonymous particularly with the vocal advocacy of opinions regarding social issues.
Therefore is it possible as a medic to be ‘apolitical’? I would argue no, because fundamentally doctors are human beings with opinions and desires of their own. This counters the traditional view that by becoming a doctor an individual ‘should be above all these things’. Frankly I find it absurd to erase the individual humanity of a medic to ‘maintain professional boundaries’, because when mediated correctly it is this humaness that allows the best medics to form strong therapeutic alliances, and improve the treatment of their patients – for example it is acknowledged that having medics of a wide variety of backgrounds ( political, cultural, religous) is beneficial in serving diverse patient populations. However professionalism is extremely important to ensure that doctors don’t overstep boundaries and provide substandard treatment to any of their patients. The British Medical Association and the General Medical Council both outline ethical guidance in this regard for doctors with some key points being:
54. You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.
59. You must not unfairly discriminate against patients or colleagues by allowing your personal views2 to affect your professional relationships or the treatment you provide or arrange
3. We recognise that personal beliefs and cultural practices are central to the lives of doctors and patients, and that all doctors have personal values that affect their day-to-day practice. We don’t wish to prevent doctors from practising in line with their beliefs and values, as long as they also follow the guidance in Good medical practice. Neither do we wish to prevent patients from receiving care that is consistent with, or meets the requirements of, their beliefs and values.https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/personal-beliefs-and-medical-practice/personal-beliefs-and-medical-practice
Within an institutionalized care setting, a physician’s political views must be tempered with their duty of care for the patient sitting in front of them. However, leaving the consultation room and entering wider society, to what extent should medics take on a political consciousness and advocacy roles? To answer this it is important to understand the inextricable linking of social policy and public health. Policies issued by the government, directly affect people’s lives – eg financial stability, social interactions and access to healthcare facilities/ programs- these in turn affect the overall well-being of an individual. The neo-liberal NHS funding strategy promoting an ‘efficient’ system, treatment of migrant workers and undocumented patients and cuts being made to social programs such as youth and breakfast clubs, are some ‘political’ issues facing the the British healthcare system that are being brought further into the limelight due to the COVID-19 pandemic. To what extent should doctors challenge the current ‘profit’ over ‘patients’ approach (engendered by a government with vested interests in capitalist ventures) with its negative long term effects on health trajectories?
I feel that it is up to the physician to decide what role they want to play with their patients and wider community. Burnout is a large problem facing medical professionals, and burdening them with responsibilities such as autonomous community organizing, compulsory rally attendance, or out of hours educational opportunities could have a counter productive result on patient outcomes. A medic from the USA pointed out to me that specialized doctors, with degrees in public health or administrative medicine, should take on these roles. Whilst I completely agree that these professionals are needed with their knowledge an experience as an invaluable asset to challenge the status quo, the anarchist in me questions the impact such medics could make when directly challenging a hierarchical system which is so deeply entrenched in our society. To me it seems that grassroots empowerment, community advocacy and educational initiatives could have a larger impact ( see my upcoming post on anarchism and medicine for more). However I also stumbled across an opinion which I have hijacked into my own schema, which posits that medical education should promote students to challenge and question hierarchies which negatively impact patient outcomes- an approach which can allow them to gain the tools and expertise to make dents in the negative aspects of the healthcare system and begin projects that can be carried on by future generations of doctors and members of their communities.
This question has not got a black and white solution. I hope to research it further and share developments in my ideology with you all. In the mean time let me know what you think about whether doctors should be political in the comments.
* for my background please see my ‘About Me’ page