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What happens when patients from opposite ends of the political spectrum sit together in your waiting room and start talking like neighbors? Psychiatrist Farid Sabet-Sharghi explores why the medical office remains one of the last spaces where shared humanity overrides division. Based on his KevinMD article, “Physician neutrality: a beacon of ethics in a divided world,” this conversation moves from the exam rooms of a polarized America to the prisons of Iran, where physicians and nurses risked torture and death to treat wounded protesters. Sabet-Sharghi shares the story of his father, a pediatrician arrested for his Bahai faith, who opened a clinic inside the very prison that held him. He draws a line from that radical moral courage to the quieter tests physicians face every day: speaking up when colleagues are mistreated, pushing back when systems reduce healers to “providers” and “prescribers,” and refusing to let financial stratification erode the dignity of primary care. You’ll hear why he now prefers “unbending moral integrity” over neutrality, how physician burnout connects to a lost sense of calling, and what younger doctors need to hear about why their work still matters. This is a conversation that will remind you why you entered medicine in the first place.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Farid. He’s a psychiatrist, and today’s KevinMD article is “Physician Neutrality: A Beacon of Ethics in a Divided World.” Farid, welcome back to the show.

Farid Sabet-Sharghi: Thank you, Kevin.

Kevin Pho: All right, so today we’re going to talk about physician neutrality, and I think that this is a very, very relevant topic with everything that’s going on in the news and the world. For those who didn’t get a chance to read your article, tell us what this one’s about.

Farid Sabet-Sharghi: Well, the article, since I wrote it, there are just so many other things happening in the world. I think as physicians, I know we are busy in our offices and our operating rooms, but there is so much going on that there is no way that we can afford not being aware of what’s happening.

So the article was really written in response to some experiences that I had sitting in my office, having my little waiting room packed with people. I used to practice in Ohio. I’m in both Ohio and Maryland DC area now, and just people from the two sides of the political divide at extremes would walk into my office with the same kind of human problems.

I was contemplating what a privilege it is, and what a really novel experience for us as physicians is, to be able to serve humanity, because we know that the beating heart is the same. The suffering is the same, the joys are the same regardless of whatever we consider that are points of division. And so I was just thinking that we are in a very special position and maybe sometimes we don’t emphasize that enough. Because nowadays we’re called everything providers. The worst one for me was prescriber. I left that job in a couple of weeks. I couldn’t tolerate that. We really have a sacred position that extends in time, millennia back. And also we are a world community. We are really not limited to our little towns or places. We should really consider ourselves as a world community.

Kevin Pho: All right. In your article you frame it from the events in the Iranian protests, and you talk about the moral courage of the Iranian physicians who documented and treated wounded patients at their own personal risks. So talk about that framing for your article and what physicians should do in the face of news like that.

Farid Sabet-Sharghi: Well, now you’re really touching something that goes very, very deep in me. The word neutrality that is used in my article really is not appropriate under every circumstance. We as American physicians have the right to be neutral, because as much as we can complain about our cultures and our societies, we are operating in generally fair conditions. Yes, we have challenges. Things have come up. We’re dictated to do this or that by insurance companies or policies that change. But within a fair system, we can remain neutral. And I think even the word neutral is not appropriate. After I wrote the article, I like to adjust it to more of unbending moral integrity.

And so, just a little bit of my experience that I did not mention in this article, and we come to the current events. In the 1980s, my father is a pediatrician. He’s 91 now. And he was practicing pediatrics in a relatively mid-sized town that had a lot of population, as the only pediatrician in a northern town in Iran. And being a member of the Bahai faith and promoting principles of like the oneness of humanity, of rights of men and women being equal or harmony of science and religion, he was arrested from his home after coming home from the office. He was very beloved in town and provided free care a couple days a week for patients who could not afford him.

It was a very dark period. I just had started medical school. Seeing him, and hearing about the news that came out, and after he was released, I was able to gather what had happened to him. He was in prison, he was tortured. He was forced to sort of recant his beliefs, which he refused to do so. But as the weeks went by, even the oppressors realized they needed his services, just so they asked him could he open a clinic inside that prison, which he was put in innocent. So my father, with the help of another pharmacist who was also in prison, they opened a little clinic and they helped not only the fellow prisoners, but people from town started coming. And the oppressors, the guards, it wasn’t their policy, it was something that was dictated by just a few bad apples from top. And we are seeing the same play replaying itself. And so that I remembered, but I almost dissociated that from my existence that I’m here as an American doctor and my issues are about insurance companies and what to be called. That level of integrity that he showed, that he managed to treat patients of all walks of life without any kind of anger or a sense of retribution, stayed with me.

And then, so the article, I don’t mention his name particularly, but some of you might be aware, of your audience, some might not, because the news has been blacked out. There is no internet in Iran. But in the recent events where at least 30 to 40,000 people, especially young people, were killed just for the guilt of coming to the streets and asking for freedom to be able to not wear veils, many of them were shot in the bad ways and they needed emergency medical care. The news that is really noteworthy for our communities is that many physicians and nurses heroically chose to treat these patients in their offices and clinics, despite the threats. And many of the physicians were jailed and imprisoned and tortured, and there are some still lingering there.

One horrific incident after this article came out last week, and now it’s verified, that a few nurses who refused to give in, and they wanted the patients to be taken away to be shot to death. And I know this is graphic for this kind of a podcast that we’re having, but it’s just to remember what they had to do. And of course these nurses were beaten badly. There were horrific acts of sexual violence and rape, and afterwards, they needed medical care. So that got me thinking, we belong to this profession that our fellow physicians, nurses, pharmacists, that they’re putting their lives in line. There were actually several dentists who were arrested and they were forced to sort of not treat the patients that needed care. So we are seeing our fellow professionals around the world showing this moral integrity to the highest. Now, I don’t think we can call that neutrality anymore. That’s just standing up for what is right to do. So the reason I’m mentioning that, perhaps hopefully we will not experience such events like that ever. Humanity will not, but their strength becomes our strength. We’re going through some changes ourselves and maybe on day-to-day offices we can remember this comradery that we have and this integrity that we have that sometimes seems to be diminished, especially with the younger generation of physicians.

Kevin Pho: So you’re telling these really powerful stories about what’s going on in Iran, and I think that physicians and other medical professionals are really holding up their utmost moral duty against really horrific conditions. And sometimes we forget that here in America when relatively speaking, we live in a just society. Tell us the message that we need to remember. And you mentioned sometimes those perhaps in our younger generation who are divorced from realities elsewhere in the world. Tell us the lessons that we need to learn when hearing about these stories abroad.

Farid Sabet-Sharghi: Yes. Again, the tests appear differently, but I think the message of human spirit triumphing is the same. And sometimes I feel like our profession, yes, we are not arrested from our offices, or we’re not tortured in prisons, but we are diminished. Sometimes we become in the service of just a financial system that calls us providers and prescribers, or just whatever else that they’re doing these days. We are units, and this really applies to physicians, to nurses, to physician assistants, to dentists, to all professions who are in the healing space. I see a lot of pharmacists who are hurting so much because the numbers and things that they have to do are impossible to do. So there’s a psychological effect.

So I would say that to take that message of resilience and self integrity into our own lives. We have tests here. They’re not the same as theirs, but we are mentally tested every day. We are asked to do things that are not appropriate. We are prevented from treating patients by insurance companies when not doing so is not appropriate. And so to me, the translation is to have that moral courage and strength to see my work and calling more than just filling forms and being done with the day. And especially again with the younger physicians, because I feel like some of them are practicing just in an era that they’re just employed and they’re told their value based on the money they make.

Let’s face it, across specialties, we are stratified, and even amongst ourselves, we respect the ones that make a lot more money than the ones that don’t as much. To me, all specialties are sacred, but pediatricians, primary care physicians, internal medicine physicians, these are special frontline physicians and nurses who are doing the day-to-day work. And I guess my message to my colleagues, especially the younger ones, is that you matter. You’re very important. You change lives, keep your spirit up. And if they’re beginning to grind you down, take a vacation, do something different. Take a CME, listen to some podcasts at KevinMD and find yourself again to be able to energize yourself.

Kevin Pho: In your article, you remind us that the patient’s right to be cared for is absolute, independent of vote, creed, or geography. When you first started this podcast, you talk about your different offices in different parts of the country, especially we live in a polarized country. So why do you think that particular principle feels especially urgent right now?

Farid Sabet-Sharghi: Because I think one of the main ways that evil, the dark side of humans operates, is that we begin not to see each other as humans. And as physicians, we don’t have the luxury to do that. Unfortunately, there are some points in history, Tuskegee Institute experiments, or during their most racist era or other parts of the world, that when physicians deviate from that, that’s just an aberration. Our tradition is always to see every human being as a beating heart. That our job is to alleviate pain and suffering. And we’ve paid a high price to be where we are. We sacrifice our twenties and early thirties to be trained, and every day we put in hours and are available to patients in certain times. To sort of remember that.

But the reason is important these times is because you begin to see some elements of people treating each other as if they’re not really part of the human race. That’s something, as physicians we need to really ward off against. We are OK to disagree with each other, to have different political views, to change our views, to do whatever we need to do socially to take care of ourselves. We can complain about taxes, pre-authorizations and all that stuff, but when we are in the office, we’re taking care of humans and that’s a sacred task. I know that word is not allowed to be used very much, for a variety of reason. Part of it is that I think the system enjoys more if we are just worker bees and providers for it, and I feel very strongly about that.

Kevin Pho: You note in your article that people are very hostile to one another in the digital space, especially on social media, but you mentioned that shared humanity within the space of the medical office, they become more polite and empathetic with each other when they see and meet each other in person.

Farid Sabet-Sharghi: That is such a good observation. And that’s exactly what I think all of us, our experiences are, that I’ve had people that in the virtual space, they see each other as just on different fronts and they want to tear each other apart. But in the waiting room, sometimes if unfortunately I’m running a bit late, they’re talking about stuff, where do you heard, I heard here, this is a good doctor or whatever, and they’re sharing with each other.

And so I guess if our waiting rooms could do that, it would be nice to think about if we could in our environments to create these safe spaces, these havens for humans to be able to sort of get together and get to know each other at variety of different levels. And our job as healers, we used to perform more of a pivotal function societally, to be the physician that people could rely on to bring that force of good. Let’s never forget that, because sometimes I see we’re allowed to have our own opinions, but we should never be hate-filled. We should be rational and logical. And so I guess that part, the neutrality comes in. But since I wrote the article, actually, I’m staying away from neutrality as much. We need to actually stand up for it.

Kevin Pho: So we are juxtaposing two situations in this podcast. We talk about the horrific violence in Iran against health care professionals versus the humanity, the shared humanity, people on opposite sides of the spectrum, the political spectrum we face here in the United States. So as a physician, sometimes, I know we’re staying away from the word neutrality, but I would say that sometimes in the United States, when we balance both sides, sometimes it sounds passive. How do you distinguish staying in the middle from silence in the face of oppression? Where do you draw the line? How do you know when you can speak?

Farid Sabet-Sharghi: I think that’s a really, really good point. There are certain things that you’re mentioning, because as you said, there is a spectrum. We also, as physicians, we study human psyche. I’m a psychiatrist, so we don’t separate mind, body. We know that there is this darkness of hatred in us, and if we’re not careful catching it early and we turn a blind eye to injustices, then it would go to extremes. Then about these events that I mentioned, these horrific events that take place, these are darknesses that have never been confronted, in my opinion.

So neutrality in our office, we observe at the immediate level to be able to take care of the people who are there. We can’t just have a deep philosophical discussion with everyone and convince them about their mishaps. But at the same time, if we see overt racism, for example, in our workplaces, that’s the time to speak up. If we see other colleagues, not because of their merit or their ability to perform a job, are not getting promotions or something happens, or there’s a good old boy system that is excluding people, we need to speak up, we need to be aware of that. Or we see different patients are being treated differently for a variety of reasons. So that’s why that neutrality then takes into the, I would say, radical moral integrity. That has been always the job of the physician, for her to stand up for that.

And I know it’s becoming difficult. I talk to younger physicians. I have my daughter who is in primary care, and it’s difficult to practice sometimes because they’re not allowed to talk about certain things, or the standards or the science behind events is being challenged a little bit. So I guess I juxtaposed the sacrifices of the physicians and nurses in Iran, first of all, for us to be aware and stand up for them. We have international organizations that we can raise our call and say that this is unacceptable and should stop, not only against physicians, but about anyone. This kind of a treatment in the world is unacceptable. And in our day to day, when we have those exhausted hours and disheartened hours, we can say we have a lot more capacity and resilience as humans and as physicians to stand up for what’s good in the world and for healing. Our job is to alleviate suffering wherever it comes from.

Kevin Pho: When you say physicians should speak up, whenever they see or hear events that go against their moral compass, what are some ways they can do that today?

Farid Sabet-Sharghi: Well, I think if we see things that are systematically excluding groups of people, we need to speak up in our medical boards, in our hospital boards. I remember my first job that I was interviewing, there was some hospital administrator, was promising me how one group of patients would be excluded from crossing this border to this town, so that makes it a better place. It was very hard, because that meant that I’m not going to get that job, to tell them that that’s an inappropriate line of thinking, action. It is not fact-based and should not be done. I was proud of myself at the moment, because that meant that I didn’t have, I couldn’t get that job, but if it was going to be that kind of an environment, I didn’t want it anyway.

And at the same time, I think formats like yours, because when we come together and we discuss things that matter to all of us collectively, it helps us. The other thing is that if we see things that don’t affect us in an environment and we see a colleague mistreated or whatever, and we feel like, well, it didn’t touch me, so I’m going to stay quiet and let her or him deal with that, that’s the wrong approach. Because that’s exactly what leads to this growth of injustice and problems that could be problematic.

The other thing is that with the younger physicians, I really emphasize the good of what we have in our practices. Because I think sometimes culturally, we value complaining about everything that is around us. But this example of putting what the Iranian physicians are going through in a way should remind us that no matter how bad we perceive things are relative to maybe a few years ago, we still have it good. I think it’s nice to say this is a good part of this system, this is very nice. Because a lot of us, I think we’re running around as if the whole town is burning and things are terrible. As physicians, generally, we’re allowed to do what we need to do. Yes, we need to be more aware. Maybe things are a little bit more difficult. Maybe the insurance companies and finances are dictating some of the course, but generally we have it good.

Kevin Pho: We’re talking to Farid Sabet-Sharghi, he’s a psychiatrist, and today’s KevinMD article is “Physician Neutrality: A Beacon of Ethics in a Divided World.” Farid, let’s end with some take-home messages they want to leave with the KevinMD audience.

Farid Sabet-Sharghi: Thank you. I guess my take-home message for myself is that we are never alone. That we have a community across time from past to present. I wrote another essay, I think with you, about Avicenna, the 10th century Persian physician who was imprisoned, this and that, but he really was the foundation of a lot of the western medicine that was taught in Spain first. So we need to see that sense of comradery across time and also throughout the world. And then we need to sort of be aware of what is going on in our own communities, in our own towns, but at the same time have a global awareness of where things are going and moving. But the translation of that should not be a disheartened, hopelessness, a sense of, I guess, gratitude and a moral rectitude to act and be full of gratitude about the field that we are privileged to serve our fellow humanity.

Kevin Pho: Farid, as always, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Farid Sabet-Sharghi: Thank you, Kevin.