Monday, October 10, 2016

Republican and Democratic medical care

Hersh ED, Goldenberg MN. Democratic and Republican physicians provide
different care on politicized health issues. Proc Natl Acad Sci U S A. 2016 Oct
3.  pii: 201606609. [Epub ahead of print]


Physicians frequently interact with patients about politically salient health issues, such as drug use, firearm safety, and sexual behavior. We investigate whether physicians' own political views affect their treatment decisions on these issues. We linked the records of over 20,000 primary care physicians in 29 US states to a voter registration database, obtaining the physicians' political party affiliations. We then surveyed a sample of Democratic and Republican primary care physicians. Respondents evaluated nine patient vignettes, three of which addressed especially politicized health issues (marijuana, abortion, and firearm storage). Physicians rated the seriousness of the issue presented in each vignette and their likelihood of engaging in specific management options. On the politicized health issues-and only on such issues-Democratic and Republican physicians differed substantially in their expressed concern and their recommended treatment plan. We control for physician demographics (like age, gender, and religiosity), patient population, and geography. Physician partisan bias can lead to unwarranted variation in patient care. Awareness of how a physician's political attitudes might affect patient care is important to physicians and patients alike.

Courtesy of Doximity

1 comment:

  1. Several medical specialties swing heavily Republican or heavily Democrat, according to unpublished data reported in the New York Times.

    For example, most infectious disease specialists (77%), psychiatrists (76%), pediatricians (68%), and geriatricians (63%) are Democrats, the researchers found. In contrast, most surgeons, (67%) anesthesiologists (65%), urologists (62%), and ears/nose/throat specialists (61%) are Republicans.

    Eitan D. Hersh, PhD, from the Department of Political Science, and Matthew N. Goldenberg, MD, from the Department of Psychiatry at Yale University in New Haven, Connecticut, compared party registration of voters in 29 states and all US physicians to sort the leanings of several specialties. The researchers used two data sets to gather the information, according to the New York Times: the National Provider Index and state voter information from Catalist LLC, a political data vendor.

    Overall, the data show physicians nationwide are fairly split between the parties, but some specialties attract significantly more members of one party or the other…

    "I don't necessarily recommend that patients ask their doctors directly about [their political views]," Dr Hersh said. "But I have raised the possibility of making a website so people could look up their doctors' political affiliation."

    "If I were looking for an ob-gyn and I had the choice of whether to see where they went to medical school or to see their party affiliation, I would choose their party affiliation," Dr Hersh said.

    He recognizes that physicians would likely rebel against such a website, but argues that from a purely patient perspective, such information should be accessible.

    "There would be a ton of resistance to it, but I'm not sure it's the wrong thing to do," he said…

    Dr Rosenthal said their findings and those of Dr Hersh and Dr Goldenberg found similar patterns indicating that party affiliation was linked with income and gender.

    "The specialties with higher average earnings were the ones that were more Republican," Dr Rosenthal said…

    David Rothman, PhD, from the Center on Medicine as a Profession, Columbia College of Physicians and Surgeons, New York City, who is a coauthor on the paper with Dr Bonica and Dr Rosenthal, told Medscape Medical News that women entering medicine has also affected the mix because more women, in general, lean more toward the Democratic party.

    He said one interesting subfinding in their research was that "women surgeons were not as Democratic as women pediatricians, but they were more Democratic than male surgeons."…

    Dr Rosenthal said another factor that has changed the landscape is employment of physicians. Regardless of specialty or gender, he said, those employed by hospitals are more likely to lean Democratic, and those in solo or small, for-profit practices are more likely to be Republican.

    That has changed the political picture as medicine moves away from the small practice model and toward the employed physician model…

    Sally Satel, MD, a staff psychiatrist at Partners in Drug Abuse Rehabilitation Counseling, a drug addiction treatment clinic in Washington, DC, and a resident scholar at the American Enterprise Institute, said knowing political leanings can also be important for evaluating research.

    "That's where agendas can creep in," she told Medscape Medical News. "Maybe people wouldn't entertain other hypotheses or other interpretations of their data," if they held strong beliefs in one ideology or the other, she said, noting that research on topics that touch on racism or disability can be vulnerable to interpretation based on world views.