The peaceful transition of power to the 47th president of the U.S. occurred January 6, 2025. It was the loser of the presidential election who ensured an orderly process and ironically certified the results.
In medicine, transitions of care – whether from inpatient to skilled nursing facility, from hospital to home, or during the passing of responsibility from one practitioner to another – represent pivotal moments in the continuity of patient treatment. These handoffs, rife with potential for miscommunication and error, are reminiscent of historical transitions of power in the U.S., where the stakes are equally high and the outcomes often uncertain.
By drawing parallels between these two domains, we can illuminate both the pitfalls and the promise inherent in such critical junctures.
The assassination scenario: chaos and urgency
When a president is assassinated, as with Abraham Lincoln or John F. Kennedy, the transfer of power is abrupt and fraught with chaos. Similarly, a sudden transition of care can occur when a physician becomes unexpectedly unavailable, such as in an emergency or abrupt resignation. The handoff of patient care responsibilities between medical students, residents, or attending physicians during shift changes can also resemble the abrupt and often chaotic transitions of power following an unexpected event, such as the assassination of a president.
In these moments, the incoming provider – like Andrew Johnson or Lyndon B. Johnson – must quickly establish authority, absorb the context of the situation, and steer the ship without prior preparation. Just as Lyndon Johnson had to navigate the minefields of the Civil Rights Movement and Vietnam War immediately upon taking office, an incoming physician must rapidly assimilate critical patient details while simultaneously making urgent medical decisions. The potential for mistakes is immense, but so too is the opportunity for decisive leadership.
The resignation: precipitous departures
The resignation of Richard Nixon in 1974 brought Gerald Ford to power under unusual and destabilizing circumstances. In medicine, this could be likened to a physician stepping away due to illness or other personal reasons, leaving behind unresolved patient issues. Gerald Ford’s task of restoring public trust parallels the challenge faced by a covering physician who must address both the unfinished tasks and the skepticism of patients and colleagues alike. Ford’s handling of the aftermath serves as a reminder that even in suboptimal conditions, stability can be restored with clear communication and steady leadership.
The lame duck: minimal engagement
A president nearing the end of their term – a “lame duck” – may become less engaged with the day-to-day responsibilities of governance. This can be mirrored in a physician going on vacation, nearing retirement, or transitioning to a new role, whose diminished investment might affect the quality of patient care.
For example, a hospitalist or locum tenens physician who knows they are leaving at the end of the month might intentionally delay addressing complex issues, leaving a larger burden for their successor. Just as the transition from Herbert Hoover to Franklin D. Roosevelt during the Great Depression highlighted the risks of disengagement, so too can a lackadaisical handoff in medicine exacerbate challenges for incoming providers.
The refusal to transition: contested handovers
Donald Trump’s refusal to concede the 2020 election epitomizes the dangers of a contested transition of power. In health care, this could be paralleled by providers who resist relinquishing control, either out of pride, mistrust, or a sense of unfinished business.
For instance, an outgoing physician may be reluctant to transfer a long-term patient to another provider, withholding crucial details or undermining the new caregiver’s authority. The resultant friction can compromise patient outcomes, much as contested political transitions strain national stability.
The harmonious transfer: similar paradigms
When power transitions from one political party to another – as from Jimmy Carter to Ronald Reagan, George H.W. Bush to Bill Clinton, or Barack Obama to Donald Trump – it often signals a dramatic shift in priorities and policies. In medicine, this can resemble a patient’s care transitioning between practitioners with differing philosophies.
For example, a holistic, patient-centered physician may transfer care to a more data-driven clinician, or vice versa. Such ideological contrasts can disorient patients and caregivers alike, requiring deliberate efforts to reconcile divergent approaches to ensure continuity of care.
However, transitions can be harmonious despite political differences. Consider the transfer of power from President Dwight D. Eisenhower to John F. Kennedy. Both parties worked to ensure a seamless handover for the good of the nation.
Similarly, in health care, detailed discharge planning, comprehensive medication reconciliation, and effective communication between hospital staff and receiving facilities are essential to prevent errors and ensure patients continue to receive the appropriate level of care.
The goal is to maintain stability and continuity, minimizing the risk of complications or readmissions, analogous to maintaining constancy during a change in leadership.
Leadership and politics in health care
The critical role of leadership and politics in health care cannot be overstated. Just as political transitions depend on the vision, competence, and stability of incoming leaders, the success of transitions in care relies heavily on strong leadership within medical teams and institutions. Leaders in health care set the tone for collaboration, advocate for resources, and implement systems that minimize errors during transitions.
Moreover, health care politics – from hospital administration to national health policy – play a pivotal role in shaping how care transitions are managed. Policies that prioritize patient safety, incentivize effective communication, and provide adequate staffing are as essential to health care as bipartisan cooperation is to governance. In both realms, leadership determines whether transitions lead to progress or regression, continuity or disruption.
Lessons from history
Historical transitions of power offer critical lessons for improving transitions of care. Just as the United States has developed protocols for the peaceful transfer of power – such as the swearing-in of vice presidents, the sharing of intelligence briefings, and the preparation of transition teams – health care can benefit from standardized procedures and collaborative practices. These might include detailed discharge summaries, structured sign-out protocols (e.g., SBAR: Situation, Background, Assessment, Recommendation), and robust communication channels.
Moreover, empathy and foresight are as vital in medicine as they are in governance. Leaders who recognize the gravity of transitions – and approach them with humility and preparation – can lessen risks and pave the way for success. Whether in the Oval Office or the operating room, the true measure of a transition lies not in the smoothness of the process but in its capacity to safeguard those most affected.
A shared responsibility
Ultimately, transitions – whether of care or power – are a shared responsibility. They demand not only the competence of the incoming leader or practitioner but also the cooperation and goodwill of the outgoing party. By acknowledging the parallels between these spheres, we can better appreciate the intricacies of both and strive to handle them with the grace they deserve. In doing so, we honor the trust placed in us – by citizens or patients – to guide them safely through uncertainty to stability and hope.
Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. He is the author of several books on narrative medicine, including Medicine on Fire: A Narrative Travelogue and Story Treasures: Medical Essays and Insights in the Narrative Tradition.
