Place patients above politics

Anti-immigration policies are hazardous to the health of immigrant patients. In the last ten years, there have been over 1,500 anti-immigration laws adopted by states across the country. These laws have come with discriminatory, racist, and xenophobic undertones, which has created a hostile environment for immigrants and citizens perceived as immigrants.

Patients don’t need to be deported or detained to be harmed by these policies, laws, and language. Research shows an association between discrimination and negative health effects, such as hypertension, low birth weight, and depression. One study showed African American teens who report discrimination have higher health risk factors such as elevated blood pressure and higher rates of obesity. Another study revealed that perceived discrimination is associated with lower health services utilization which hinders management of chronic diseases. Discrimination and immigration also run along with other social determinants of health such as poverty, housing instability, social isolation, and limited educational opportunities.

Training in medicine has been insufficient in addressing the issue of discrimination in relation to health. Additionally, doctors-in-training are rarely asked to incorporate the effects of structural and political transgressions into their clinical formulation of a patient’s presenting complaint. The good news: There has been a mounting movement to promote what’s called structural competency within the training of medicine. Structural competency is a framework to understand how illness and disease is linked to institutional and structural factors contributing to discrimination and social marginalization.

To be sure, these are complex problems that no one doctor or person can solve. The conversations can be uncomfortable and possibly contentious. Doctors may fear by discussing these issues they are bringing their own personal views and bias into the exam room. Well, guess what? It is already there, and left unspoken, it leaves patients to decide if a physician is caring for them on behalf of the patient’s best interest or our own. And the evidence showing that patients’ health is suffering is piling up.

As doctors, we took an oath to care for our patients, and with that we are sworn to protect our patients from physical, mental, and societal harm under our purview. It is for this reason physicians must become familiar with the impact anti-immigration policies will have on the patients we serve. By doing so, we can help protect our patients from unlawful discovery and deportation, which may mean separation from their family and poor health maintenance during detention.

It is our job to inform and work with patients to prevent preventable diseases and relieve suffering. Physicians should inquire about how the recent climate regarding immigration is impacting their family and if it is causing symptoms of anxiety or depression, in addition to physical symptoms of distress. Lastly, physicians should know their rights regarding what to include in medical records, as well as reporting suspected injury related to a hate crime.

Abstaining from the political fray undermines the human rights of patients. It also jeopardizes the public health of the nation by further marginalizing a population with higher likelihood of social and medical needs.  Politics has come to rest on our stretchers. It’s time for doctors to take a stand, and we should choose to respond by respecting humanity and protecting the health of our patients.

Courtney McMickens is a child psychiatrist.

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