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Where to draw the line on talking to our patients about health reform?


I was sent a troubling email last night from a Doctors for America physician in Dayton Ohio.  He had gotten wind of a group of Ear Nose and Throat surgeons in Dayton, Ohio who sent all of their patients an anti-health reform letter.  The letter is more inflammatory than most as it pulls in rhetoric that goes beyond anything related to health care...AND because behind the top coverage page is a familiar list of myths about HR3200.  These myths have been debunked and dismissed -- yet here they are again in the mail boxes of patients... sent by their doctor!  Scary!

No wonder most folks don't know who or what to believe.  How can anyone sift through all the information (and mis-information) and really understand the truth?  You can see many of the falsehoods and myths debunked, once again at

But what about the larger ethical question about talking to our patients about these issues?  Where should we draw the line in talking to our patients about politically charged topics?

The AMA policy on physicians' political communication with their patients states: "It is natural that in fulfilling these political responsibilities, physicians will express their views to patients or their families. However, communications by telephone or other modalities with patients and their families about political matters must be conducted with the utmost sensitivity to patients’ vulnerability and desire for privacy. Conversations about political matters are not appropriate at times when patients or families are emotionally pressured by significant medical circumstances. Physicians are best able to judge both the intrusiveness of the discussion and the patient’s level of comfort. Under no circumstances should physicians allow their differences with patients or their families about political matters to interfere with the delivery of high-quality professional care."

That advice is pretty vague.  In a Huffington Post article by Arthur Delaney posted yesterday, Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania is quoted saying, "the trick is: Do not coerce, intimidate, or be seen as pressuring your patients. It is risky to be proselytizing patients in the office, because while you may not intend to coerce them, they may hear it that way. If you feel like you can't speak back, respond and argue, you're being coerced. If somebody says, 'I felt like I had no choice but to sit there and listen,' they're being coerced."

As I think about the mission and activities of Doctors for America in support of health reform --I am re-evaluating how physician should interact with their patients on this issue.  I truly believe there is consensus on the benefits of health reform... but things have become so politically heated, that it is hard to deliver a pro-reform message without sounding partisan.  So, I throw the question open to the masses.  Where should physicians draw the line in terms of talking about health reform with their patients?

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