How Doctors' Political Ideology Influences Patient Care

By Jasna Hardin, PharmD

You have an appointment with your doctor. You arrive at the office, wait for the nurse to call your name, and then proceed to the room assigned for your care. Once inside, the consultation process begins wherein the doctor reviews your medical chart, conducts a physical examination, provides medical advice, and if needed, prescribes new or better-suited medication. Although we may not think much about it, this interaction, which we’ve experienced many times, may be fraught with the same motives and biases that inflict us all (Groopman, 2007).

In addition to everything else that the COVID-19 pandemic has revealed about our medical system, it has also brought to light the troubling realization that seemingly no topic, not even our personal healthcare, is devoid of politics. Beliefs entailing COVID-19’s existence, its severity, and how to approach its prevention and treatment have all been ideologically driven, with results corresponding to predictable left-right divides (Calvillo et al., 2020). And while it may be easy to argue that COVID-19 presented a unique historical context in which politics infiltrated medical science and practice, research unfortunately shows otherwise.

Physicians Are Political

Physicians are political, and one way in which they signal their beliefs and values is through the founding or joining of physician-led organizations or networks that are politically focused. Such groups include Doctors 4 Gun Safety, Doctors for America, Doctors for Responsible Gun Ownership, the American Association of Pro-Life Obstetricians and Gynecologists, and Lighthouse, an organization for LGBTQ-friendly healthcare providers. By becoming a member of such a group, a physician is proclaiming their stance on a politically charged topic, possibly giving reason for others to believe that they may be motivated to provide or withhold certain types of patient care in line with the ideologies they endorse.

While being a member of a politically focused group may be an explicit way for physicians to integrate their beliefs and values into their practice, the process can occur in more subtle ways as well. Past research has found that the healthcare provided by physicians can be ideologically motivated, especially on topics that are politically sensitive.

In one study, researchers Eitan Hersh and Matthew Goldenberg (2016) surveyed primary care physicians and found that physicians identifying as Republican rated the seriousness of clinical vignettes involving marijuana use, firearm storage, and elective abortion differently than physicians identifying as Democratic. Subsequent treatment options were obtained from the same physicians regarding the same clinical vignettes and were again found to differ in line with political party affiliation. The importance of this study is that it shows how the personal beliefs held by physicians can influence the care they provide, and that this care may fall along predictable ideological lines.

Racial Disparities in Pain Management

Unfortunately, racial disparities in the management of pain are fairly common. For the treatment of acute pain, numerous studies have found that while in emergency departments or at the time of discharge, non-White patients are less likely to receive opioids for the treatment of their pain (Mills et al., 2011; Pletcher et al., 2008; Singhal, Tien, & Hsia, 2016).

Studies have also revealed similar disparities in the treatment of chronic pain. A recent meta-analysis, which included studies conducted over a 20-year period from 2000 to 2020, showed that there are racial and ethnic differences in the treatment of chronic pain and long-term monitoring of opioid use.

More specifically, minorities, especially Black patients, were less likely to receive opioids to treat their chronic pain and were also more closely monitored for possible opioid misuse when receiving long-term treatment (Morales & Yong, 2021). While these studies were not designed to explore the relationship between patient care and physician ideology, the broader research literature suggests that conservatives are more likely to exhibit racial biases such as these.

Conservatives, when compared to liberals, tend to be more supportive of tradition, hierarchy, and inequality. They may also be more likely to endorse racial disparities because of a motivated process to justify the existing social order and satisfy certain psychological needs (Jost, 2021). These findings may provide some context for understanding racial disparities in the treatment provided by physicians for acute and chronic pain.

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COVID Polarization

While it’s important to recognize the ways in which politics can enter the examination room in general, it is especially important to understand how the healthcare surrounding COVID-19 became so politicized—and how that politicization affected patient care. The use of the COVID-19 vaccine is one such area of political contention, with research indicating that while many Americans expressed concern about getting vaccinated, conservatives expressed more concern than liberals (Funk & Gramlich, 2021).

Prior research has established that physicians’ recommendations increase vaccine uptake by patients. However, Callaghan and colleagues (2022) found that physicians identifying as extremely conservative were less likely to agree that vaccines were safe and effective, in comparison with extremely liberal physicians.

These results suggest that a primary care physician’s belief in the safety and efficacy of vaccination can to some extent be ideologically motivated. This, in turn, may have contributed to the differences in COVID-19 vaccine uptake between conservatives and liberals.

Findings such as the above also suggest that political polarization can impact the healthcare we receive. Ideological polarization occurs when groups on the left and right move away from one another in one or both directions when it comes to beliefs, opinions, and values (Jost, Baldassarri, & Druckman, 2022). Insofar as differences in vaccine confidence were most pronounced when comparing extreme ideologues from each group of physicians, these patterns point to potentially deleterious downstream effects of political polarization in the domain of healthcare.

Early in the pandemic, former President Donald Trump heavily touted the use of hydroxychloroquine for the treatment and prophylaxis of COVID-19. While scientific research to that point provided little evidence regarding its efficacy, and therefore little reason to recommend its use, Trump’s persistence contributed to the politicization of the issue, and prescription rates for hydroxychloroquine significantly increased throughout the country (Bull-Otterson et al. 2020; Harrigan et al. 2020).

A study conducted by Madanay and colleagues (2022) showed that prescription rates for hydroxychloroquine were higher in areas of the country with greater support for Trump in both the 2016 and 2020 elections. However, it is not entirely clear whether the increase in hydroxychloroquine prescriptions in conservative regions was attributable to physician ideology or patient demand.

In any case, it is important to recognize that physicians have the ultimate say in what they prescribe, regardless of the demands made by patients. The worry, of course, is that for ideological reasons physicians are either recommending or succumbing to the demands of their patients for a treatment that shows little scientific evidence to support its use.

Conclusion

It may not be too surprising that physicians, like the rest of us, are political. They, too, endorse political ideologies that shape their attitudes and behaviors. Unlike most other people, however, the decisions physicians make can profoundly impact the state of our health, and as such, it is crucial to understand how the belief systems embraced by physicians influence the care they provide to patients.

As political polarization continues to rise and healthcare becomes an increasingly politicized field, our only way to safeguard and improve patient care so that it is equitable, responsible, and ethical for all is to ensure that every physician recognizes that healthcare should not be guided by political beliefs, but rather high-quality scientific research. When the space between physicians and their patients becomes a battlefield for political struggle, whether intentionally or not, a patient’s best interest ceases to be the preeminent factor on which care is based.