Experts say there's an elephant in the exam room when it comes to politicized health issues, and it could be bad news for patients.
After five years of mostly unsuccessful treatments for her Crohn's disease, Chele Reid, 34, decided to try something new: marijuana. Reid, who lives in Cleveland, had heard that her state recently legalized the drug for medical use and she wanted to talk to her doctor about it.
"I had prepared a list of questions, but I didn't get even through one of them," Reid says. "When I mentioned marijuana he began steering me in another direction. His response didn't seem medical—it felt personal. He was talking about things like the impact of long-term drug use on people. He said it would cause me to have memory problems, and possibly even turn to harder drugs eventually." (Although research out of the University of New Hampshire shows that in most cases, that's not true.) Instead, he offered a different treatment that involved, well, drugs—but the nice, round, poppable kind. "I just let it go because I sort of felt judged," she says.
Reid, who occasionally puffed (but mostly passed) weed in high school, wasn't looking for a doctor's pass to validate her need to carry grass. She was looking for legitimate relief from a medical condition that left her hollowed out and thin, torn and leaking from her most private of places. She was desperate and depressed. And indeed, there's research showing cannabis use may have anti-inflammatory properties that help with Crohn's disease.
Experts say Reid's experience is a classic case of physician political bias—when a doctor's political leanings color the care they provide on controversial health topics from reproductive choices to LGBT health issues. (Related: Why the LGBT Community Gets Worse Health Care Than Their Straight Peers) Here's what they want you to know about it, plus what you can do.
Underneath the White Coats
The American Medical Association (AMA) is clear that it opposes discrimination based on sex, sexual orientation, gender identity, race, religion, disability, ethnic origin, national origin, or age. And the Hippocratic Oath, a text held sacred by doctors, obligates those in the medical community "to treat the ill to the best of one's ability...." So even if he didn't explain it, Reid's doctor could have had legitimate medical reasons behind why he didn't suggest smoking her disease away. (Side note: Ohio's medicinal marijuana law wasn't fully in effect.) And to be fair, researchers (including those in the study mentioned above) say that marijuana as medicine needs to be further studied. (More on that here: The Health Benefits and Risks of Smoking Pot, According to Science)
But according to one study published in the journal Proceedings of the National Academy of Sciences, there could have been another reason: "Our study found that primary care physicians who are Democrats differ from primary care physicians who are Republicans in their recommended treatment plans to patients with certain politicized health issues," says Matthew Goldenberg, M.D., associate professor of psychiatry at Yale University and one of the study's coauthors. "This suggests a physician's political affiliation matters."
The research found that while we may think of exam rooms as cold, neutral-white places, they're often splattered with the red and blue stains of party-driven beliefs on hot-button health issues (think: abortion and marijuana use). The research polled over 200 doctors who were not told the purpose of the questions. After going through a series of hypothetical scenarios, responses revealed that Republicans and Democrats differed on how they would treat certain medical issues. What the research did not determine is if that had a negative or positive outcome on the patient. (Although religion wasn't studied, it's "certainly possible" that it could also affect a doctor's approach to health care, although more research is needed, Dr. Goldenberg adds. However, given that religious beliefs often come into play when determining one's political affiliation, it doesn't seem like a far-fetched conclusion to reach.)
To some, the idea that a physician's political preferences would seep into the treatment room is a head-scratching notion. "I spent more than three decades practicing medicine, and consider myself a physician first and foremost," says Phil Roe, M.D., a Republican representative from Tennessee who co-chairs the GOP Doctors Caucus and is the chairman of the House Committee on Veterans' Affairs. "I've said time and time again that I've never once treated a Republican or Democrat cancer in my life; party affiliation should have nothing to do with patient care."
But other medical experts disagree. "I do believe some medical professionals' political and religious beliefs impact how they treat patients," says Shoshana Ungerleider, M.D., a hospitalist physician at Sutter Health California Pacific Medical Center in San Francisco. While cancer treatments may seem benign, what if you wanted to use marijuana to lessen chemotherapy symptoms? What if you wanted to get an abortion because you just found out you had life-threatening cancer? What if you were a transgender patient who wanted to know how the cancer treatments would impact your daily hormone intake? Now we're getting political.
Not to mention, politics has punctured holes in health care for decades. Case in point: Abortion access varies depending on where you live. And some states, like Mississippi, have religious exemptions for doctors that give them permission to refuse treatment to LGBT patients.
What You Should Do About It
Understanding that health care isn't always black and white—sometimes it's red and blue—is the first step to getting the best medical care you can, Dr. Goldenberg explains. "That should empower patients to ask their physicians about specific treatment options or to seek a second opinion."
And while it may not be the most scientifically proven method: Go with your gut, Dr. Ungerleider says. It's important to connect with the person you entrust your care to, and you usually know when something feels off. "If you feel that you can't be open and honest with your doctor, leave and find someone you're comfortable with," she says. Consider it doctor's orders.