Should medical school encourage political thought?

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Many medical schools don’t encourage political thought in their students, far less nurture it. That’s a shame because it squanders an opportunity to equip future thought leaders to deal with serious concerns facing the U.S. population, many of which have their tentacles in politics.

In “Experiencing Politics,” a memoir about his 12-year stint in the Massachusetts House of Representatives, Harvard’s John McDonough offers an accessible argument about why health care — and medicine by extension — is an inherently political issue. His argument is partly inspired by Niccolo Machiavelli, the infamous 16th-century Italian diplomat. McDonough’s argument can be distilled like this:

  • Human nature is insatiable, so humans quibble over limited resources.
  • Health care is a limited resource.
  • Humans will quibble over health care.

Politics is the way that civilized societies are supposed to decide how limited resources should be distributed. It makes sense, then, to say that health care is a political issue.

In medical school, politics — like most “nonmedical” things — tends to be a distraction. Medical students are generally taught to believe that medicine and politics are not overlapping entities. Clinical medicine, especially, is taught in the vacuum of a perfect world, almost entirely divorced from the reality faced by many of our future patients.

To reach a diagnosis, we are often presented with one test to run after another, as if our patients will never have to foot the bill. Have a patient with chronic migraines? Order a CT scan. Can’t see anything unusual on the CT? Run an MRI, just to be sure. A workup like that may very well be needed in certain situations, but it’s rarely emphasized that some patients can barely afford a CT scan, much less an MRI.

Or take the example of allergies, which are even more common. What to do for a child who has gone into anaphylactic shock? Without hesitation, every medical student will say to give the patient epinephrine and write the child a prescription for EpiPens. But with the skyrocketing prices of EpiPens in the last two years, they simply aren’t an option for many families anymore.

What good is teaching medical students to recommend treatments that patients won’t use because they can’t afford them?

Most medical students — and most of their teachers — will say that medicine and health care should transcend political debate. In a perfect world, it probably should. But that doesn’t happen in the real world, where people tend to pick sides. For instance, the signature legislation of Barack Obama’s presidency was the Affordable Care Act. Thus far, the signature goal of Donald Trump’s presidency seems to be to repeal and replace the ACA, with an emphasis on “repeal.”

The disconnect between medicine and politics by medical schools doesn’t mean medical students are apathetic. When President Trump threatened to end the Deferred Action for Childhood Arrivals Act, and eventually did so, medical students across the country began social media campaigns, standing up for their colleagues and loved ones who are dreamers. Similar campaigns at medical schools followed the birth of the Black Lives Matter movement, with schools such as the University of California, San Francisco, arranging die-ins that ultimately culminated in the nationwide White Coats for Black Lives movement.

Yet the culture of medical education fails to emphasize the messy entanglements between medicine and politics. A class on health policy cannot replace classes on pathology or pharmacology, nor should it. But without making policy and public health a major component of medical education instead of a side interest to be pursued on students’ own time, medical schools will continue to churn out exceptionally talented physicians who are exceptionally ill-prepared to deal with the medical bureaucracy and byzantine health care policies that hit them the moment they begin to care for patients. Physicians are no longer just healers, but must also advocates for their patients against these bureaucracies and policies.

I don’t believe there is anything immoral about entering medicine with the sole intent of healing people and hoping to have minimal entanglement with the policy side of medicine. But I do believe that is naiveté to the point of fault. We know from public health research that it is difficult to improve outcomes for many patients without simultaneously improving their socioeconomic circumstances. Physicians who are inadequately prepared to tend to these needs through civic engagement face a steep learning curve that takes a while to summit. This limits their effectiveness as healers.

More than 2,000 years ago, Aristotle concluded that human beings are political animals. I think it’s time that medical schools and medical students acknowledge that reality and do something about it.

Faiz Kidwai is a medical student. The author thanks Dr. David Annas and Dr. Mary Hon for their contributions to this article. This article originally appeared in STAT News.

Image credit: Shutterstock.com

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