Politics and the Patient Encounter, in Dire Times

— We have a responsibility to explain to patients how policy changes may transform their care

It's traditionally been frowned upon for us doctors to talk with patients about voting. But at a time of growing crisis in healthcare, clinicians now face an important decision in the exam room. Should we override the conventional prohibition against bringing up political issues with the people we're caring for?

In these times, I'd argue that we can -- we must -- do so to fulfil our duty as healthcare professionals.

Consider these analogous situations: If a busy primary care doctor was about to retire, he'd be expected to notify his patients so they could ensure continuity of their care. Or if her clinic was about to be shuttered, it would be irresponsible not to let patients know. Or if the drugstore where they fill their prescriptions was closing and leaving a "pharmacy desert" in their neighborhood, he'd be remiss not to share that information so people could make other plans, to protect their health.

In these unusual times, I'd argue that healthcare professionals have an ethical responsibility to explain to our patients the ways that imminent changes in government policies are going to transform the care that many of them will -- or won't -- be getting. An important part of being a doctor is teaching people about the factors that impact their health and then educating them about what they can do about them. Many of those we care for don't even see these blows coming. It's the same as the imminent retirement of their doctor or the closing of the office or pharmacy they've been going to for years: We are responsible for proactively informing our patients about these changes and helping them take protective action.

Here's one conversation I'd be having if I were still actively seeing patients:

"Mr. White, last year Congress passed a law that's about to end your Medicaid coverage. Because of that, the government will stop paying for the heart, diabetes, blood pressure, and psychiatric medicines I've prescribed for you, and I know you can't pay for them out of pocket. Some specialists I'd want you to see may not give you an appointment if you don't have insurance. If you need to be admitted to the hospital, you'll probably be responsible for paying that bill yourself in the future, which will be more than you can afford. Our clinic will do its best to let me keep seeing you, but we'll have to do so without getting paid. That will limit some of the care we can provide, since so many of our patients will be losing their coverage at the same time."

The next big wave of cutbacks will take effect soon after January 1, when the "One Big Beautiful Bill" will begin to exclude millions of patients from Medicaid -- a change timed to kick in after the midterm elections. Many doctors already began having these tough conversations with other patients after the administration ended the Biden-era subsidies that helped middle-class patients keep their Obamacare coverage. Even our more well-off patients are finding their private health insurance or Medicare premiums are becoming unaffordable, driven ever higher by rising prices for medications and medical services. Some Medicare Advantage plans will be cut in many parts of the country.

The audiences for these proposed conversations aren't just poor patients. More pain is imminent for everyone, including the wealthiest among us, as emergency department (ED) delays and crowding become even more unbearable. That's because all the people who lose their Medicaid or Obamacare coverage won't be able to access primary care or medications anymore, throwing huge numbers of them into our already overwhelmed ED settings when they become acutely ill.

The goal here isn't to alarm patients. If I found a malignant tumor or a potentially fatal arrhythmia, I'd be responsible for explaining the condition and then advising what a person needs to do to preserve their health. It's the same here:

"Mr. White, most of these changes are being caused by new laws and policies the federal government put in place last year. But next year a new Congress could try and undo some of those cuts. Everyone in the House of Representatives and a third of the Senate will be running for re-election soon. I suggest you find out where the people you'll be voting for stand on these cutbacks, and act in a way that can best protect your health."

At a time when expert credibility of all kinds has taken a hit across the country, doctors, nurses, and other health professionals remain among the most trusted people in society. Even non-professional medical office staff, who often spend a great deal of time with patients, can serve as reliable advisors on this specific issue.

We've long known that person-to-person conversations are among the best ways of persuading people to take action in their own best interest. A few words from one of us can make a bigger difference than thousands of dollars of political commercials.

So, is it ethical for doctors and other healthcare professionals to initiate talks like this with their patients as part of our responsibility to protect their health? Of course it is; it would be unethical not to do so. This needn't mean telling patients which candidates to vote for, but informing them about their health-related policy choices ought to be part of our job in this unusual moment in history. And if they ask for specifics about which candidates support which health policies, we should be prepared to offer that information.

At a time when access to medical care is being reduced more drastically than ever, the responsibility to educate the people we care for about how to protect their health should be on the "active problem list" for each of them, now and for at least the next 2 years. For better or worse, it's an obligation that clinicians will continue to have long after the midterm elections are behind us.