By Jamie Nicole LaBuzetta, MD, MSc, MPhil, Division of Neurocritical Care,Department of Neurosciences, UC San Diego Health
In the early 1990s, most physicians were Republicans. Three decades later, the demographic composition of the medical workforce has shifted1, 2, and so has the overall political alignment of physicians. Now, physicians are roughly split between the two major political parties, though data suggest that some specialties have political tendencies; for instance, practitioners in fields such as surgery lean Republican, whereas those in psychiatry or infectious disease are more than two-thirds Democrat2. Relatedly, there is also interesting literature to suggest that intrinsic political ideology shapes some major treatment decisions and health systems attitudes3. There are a number of hypotheses for this shifting landscape, but the major ethical point is that roughly 50% of our colleagues—whom we presumably respect as people and for the care and expertise they provide—will not share our political preferences and affiliations, and this disconnect has the potential to impact the workplace in unexpected ways.
On January 6, 2021, our nation witnessed something that hadn’t been seen for over 200 years: a mass attack on, and invasion of, our Capitol building. When I walked into the team room shortly after the completion of rounds, mouths were agape and there were a lot of majority-led, anti-Trump murmurings. What these individuals did not notice was the trainee sitting with downcast eyes, shifting in his seat, decidedly not insulting our shared President. When I checked in with this resident, I found the conversation had made him very uncomfortable. He hadn’t told his neurocritical colleagues (nor should he have to) that he voted for Trump because he worried what his colleagues might think of him, and the ridicule or harassment that he might have to endure... harassment that he had already endured during other rotations.
As the medical field continues to diversify, so too shall our opinions and views. Our commitment to our patients and our colleagues is that we won’t let these impact our care and our professional relationships. The NCS Code of Conduct provides a guideline for the ethical behavior of Neurointensivists and for members of NCS. Within this Code of Conduct, there is an emphasis on respect for patients and colleagues. Where differences exist, it is important to try to grow through “active listening” and “consensus building”4. Political identity is an important part of self-identity, and people need to be aware of the ethical (e.g., implicit bias) and practical (e.g., workplace conversation) implications of these political tendencies. Our arguments should never be focused on “ad hominem” attacks4, bullying, denigration of beliefs, or name-calling. We deserve better than that, and we have a professional responsibility to be better than that.
- Frank E, Carrera J, Dharamsi S. Political self-characterization of u.S. Medical students. J Gen Intern Med. 2007;22:514-517
- Sanger-Katz M. Your surgeon is probably a republican, your psychiatrist probably a democrat. The New York Times. 2016
- Hersh ED, Goldenberg MN. Democratic and republican physicians provide different care on politicized health issues. Proc Natl Acad Sci U S A. 2016;113:11811-11816
- Rubin M, Bonomo J, Bar B, Collins E, Cruz-Flores S, Garvin R, et al. The code of professional conduct for the neurocritical care society. Neurocrit Care. 2015;23:145-148