A guest column by the American College of Physicians, exclusive to KevinMD.

Political divisiveness has always been part of the fabric of America.  Even as our Founders laid the groundwork for the United States, they understood the challenges of seeking to assemble a unified and functional country from such a wide geographic and culturally diverse landscape.  In establishing a country based on the central principles of freedom, liberty, and a shared common good, they also recognized that in a free society there would always be an attraction to personal and tribal instincts that, if not tempered, could threaten the function and even the existence of the fragile construct of a democracy.  In fact, George Washington called partisanship in its most extreme form a potentially fatal tendency inherent to democratic systems.  This is why our country’s operational principles are enshrined in a constitution with mechanisms to moderate partisan impulses, such as the separation of power and multiple checks and balances on how it is manifest.

Although our country has managed to survive and ultimately thrive since its founding, our history has been punctuated by periods of extreme political upheaval, including one that led to a devastatingly traumatic civil war.  And it now seems that we again find ourselves in the depths of another period of significant political divisiveness as seen in the rhetorical vitriol present in the public square, an inability to work from a set of accepted basic facts, or agreement on what actually constitutes the common good.  This politically polarized climate is seemingly permeating nearly every aspect of our society, including our culture and even sports, both of which have traditionally been safe retreats for many from daily life stressors.  And the politicization of medically-related issues has had a markedly negative impact on the health of our nation, society, and individual patients.

This current level of divisiveness has compromised the ability for us to collectively address our most urgent public health needs, which has in turn exacerbated the suffering and death toll we have experienced during the concurrent pandemic.  And we have also not been able to effectively confront and rectify the other economic and social determinants of health that have been so dramatically exposed during the global health crisis.

This divisiveness has also extended into the patient-physician relationship.  Effective medical care requires that we frequently engage with patients around potentially politically salient health issues such as sexual behavior, drug use, or firearm safety.  And in the time of a pandemic, we are obligated to discuss personal and public safety measures such as mask-wearing and immunization.  However, in my own practice, I sense a markedly increased level of wariness, suspicion, and at times downright anger by patients when even broaching these important topics.  I’ve even had patients, some of whom I have followed for many years, seek to provoke interchanges around those things they feel strongly about from a political perspective.  This has clearly damaged the ability to establish and sustain meaningful therapeutic relationships and mutual commitments to working alongside many of our patients in seeking to maintain and improve their health.

So as physicians, how do we begin to bridge this political divide and work toward developing a less divisive culture and restoring a genuinely collaborative approach toward optimizing our society and patients’ health?

Although there is no easy or perfect answer, we can start by remembering that health care has always been a primary human issue long before it became a political one, and will certainly remain so once we are able to move beyond our current level of divisiveness and polarization.

As a profession, it’s critical that we continue to provide consistent, scientifically-based, and unbiased information regarding health-related issues devoid of, but not being insensitive to, the potential social or political meaning that it may have for many.  But perhaps more importantly, we need to identify and seek to build consensus around those health outcomes that we share and mutually value as humans, regardless of our political viewpoints, as a way of transcending our divided culture and enabling us to work together to find practical solutions to achieve them.

And at the individual patient level, it requires that we similarly seek to find common ground around health issues that are most important to them, and do so in a compassionate, empathic, and non-judgmental way.  Only then can we connect with them in the truly human-to-human way based on mutual interest and respect that is central to the patient-physician relationship.  In this way, we can hopefully develop a sense of trust with each other and rise above the reflexive, emotional responses that result in the divisiveness and polarization that has been so damaging in the current environment.

In the end, we need to understand that the same deep passions that are the foundation of our divisiveness are much the same as those that brought us together as a society and country in the first place.  The challenge is for each of us to understand that what unites us far exceeds those things that divide us, and that the health of our patients and nation will be better if we can recognize this.

Philip A. Masters is vice-president, Membership and International Programs, American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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