As clinicians, we’re constantly exposed to individuals from all walks of life. Treating homecare patients brings me to the doorstep of this reality. And as patients open their homes to me, I bear witness to the diversity that makes this country so unique.
As an OT, I’ve worked with patients, families, care team members and colleagues who lean far left, far right, and all points in between. I’ve seen stickers, flags, posters, buttons, masks, and various memorabilia, and I am awed at the history behind it all. I have worked among patients and colleagues who were Black Panthers and Communists. I’m fairly certain I’ve had patients who fought on both sides of World War 2, and I’ve had many that were civilian survivors of it.
I’ve had patients and colleagues make many assumptions about my heritage, religion, and political dispositions. Sometimes I find it easier to go along with their assumptions, neither confirming nor denying them, but I prefer to approach with an understanding that in their vulnerable state they may be trying to find common ground and build the foundation for a therapeutic relationship.
Professionalism v. Politics
One day, after this last presidential election, I walked through the door of one of my patients, and the patient’s spouse showed me a pile of stamped envelopes addressed to Donald Trump. The spouse selected the one on top with every intention of adding my address and having me sign the letter inside. I politely declined, and this was met with an assumption that my resistance to signing the letter meant that I had an opposing viewpoint, or that I was apathetic to this social cause. I respectfully said that although I wasn’t comfortable signing my name on the activism form letter, I’d prefer to consider the points within and draft my own.
As I removed my coat and boots in the doorway, I was barraged with facts, figures, opinions, and pleas. “Well, I hope you DO write that letter!” he said, along with other reasons why I needed to sign – or suffer the consequences. No doubt, this made me uncomfortable. Indeed the implications could be vast. I considered explaining that I came to treat my patient – a neutral party, if you will.
Instead, I tactfully, but with an inescapable sense of awkwardness, extricated myself from the line of fire and proceeded into my patient’s room to begin treatment.
As the moment passed, I couldn’t help feeling jarred. Would the patient’s spouse hold my decision against me? Would this adversely affect my relationship with the patient or worse, deteriorate the trust this family had put in my ability provide proper care?
Months have gone by since this particular interaction, yet there have been numerous situations since, involving patients, caregivers, and work colleagues who’ve expressed strong opinions or emotions around me in the wake of this current sociopolitical climate, during the workday.
Stories about depression-inducing news coverage, which we can’t seem to escape; disparate viewpoints; anger, frustration, passion, positioning: these have all been overheard at various homes and SNF rehab gyms. Moments sometimes overheat and loud debates have ensued. As a professional in the workplace, this requires significant on-the-spot ethical considerations. Decisions must be made about whether or not to engage, along with consideration of the potential consequences of such engagement for oneself, the patients, and indeed the wellbeing and cohesion of the entire department.
The Neutral Stance
Self-containment in the current climate requires tremendous discipline. For a professional, it underscores the nature of the term itself. Oftentimes I reflect on the word itself: professional. Its implications beseech prudence, especially in the workplace. Patients come first. The mission is straightforward: giving care, improving lives, and supporting those with whom we work.
Before I engage, I often ask myself: will this conversation benefit the wellbeing of my patient? While it’s impossible not to have an opinion, I’m confident that communication on other topics has a far greater ability to build meaningful, therapeutic relationships. This is why I’ve made an effort to abstain.
But I believe it’s important to recognize how today’s political challenges have had a daily impact on my ability to balance my professional work with my desire to also be a compassionate, empathetic, and supportive healer to all.
Clinical Effects of Neutrality
Fearful that the 2016 pre-election environment would “raise blood pressure and heart rates, boost cortisol levels, and exacerbate diabetes or chronic obstructive pulmonary disease, “ a cardiopulmonary rehabilitation hospital in Southampton, New York installed signs in their therapy gym stating a “no debating politics” policy as a response to the stressful yelling among their cardiac patients using the treadmills and airing their opinions.[i]
In the interest of patient stress levels, my colleagues and I have loosely agreed to a “no debating politics at work”. When the environment is out of my control, such as in a SNF’s gym or rehabilitation office, I focus deeper on my work – my patient – my notes, asserting my neutral stance. Or, when possible, try to physically avoid the discussion by moving to a different desk or area of the gym.
Dr. Weinstein, a corporate consultant known as “The Ethics Guy” discusses Five Ethical Principals[ii] pertaining to taboo topics while in the workplace: “Do No Harm,” “Make Things Better,” “Respect Others,” “Be Fair,” and “Be Loving”. In other words, politics is one of those subjects that has the potential to divert attention away from the above principles, putting job performance and work relationships at risk.
While a neutral stance is the textbook conventional way to handle political conversations at work, I must acknowledge that my neutrality may unintentionally incite others. The moral distress felt by the neutral party may inadvertently incite some, which is why I often remember the old saying: out of sight, out of mind. And I move away. I step aside. I take a break.
Patient-Centered Care: Engaging The Conversation
In a New York Times opinion piece entitled “Why Therapists Should Talk Politics”[iii], Richard Brouilette, a psychotherapist, insisted that practitioners consider not just internal factors but also external factors that may be affecting our patients. This isn’t a new concept. Occupational therapy students learn this early on in their curriculum. However, when considering external factors such as political climate, this seems to be at odds with the “no discussing politics at work” ethic. Instead, Brouilette’s piece considers political dialogue necessary, supportive, and potentially empowering, an opportunity for a therapist to guide a patient along the fine line between self-awareness as a catalyst to change as well as adjustment to external factors and advocacy as a catalyst for change. He wrote, “Therapists need to consider such political interaction… as inherent to the therapeutic process. Patients become motivated to change the world around them as a solution to what had become internal stressors. This is an experience of not just external but internal change, bringing new confidence and a sense of engagement that becomes a part of the patient’s character.”
If we’re attuned to our patient’s environment and emotional state, perhaps listening to their political concerns and those of their family could indeed be another way to gain further insight toward providing patient-centered care. Providing a confidential space in order to address the topic of politics may potentially trigger epiphanies that lead to the root of anxieties, stressors, tensions, or fears. In turn, this insight and awareness may have a positive affect on therapeutic interventions and further enhance focus on patient interests, goals, habits, motivation, and endurance. In the ideal, this would lead to further success with daily vocational and avocational activities.
Suggestions for Health Care Workers in a Politically Polarized Climate
The New England Journal of Medicine considered ways that Health Care workers could help in a politically polarized climate[iv]. The article stats that clinicians must be aware that patients may not be as forthcoming when discussing the sociopolitical impact on their health due to fear of discrimination or judgment. Thus, a safe, supportive, judgment-free space must be created for patients by sending a clear message that health services are for all people and that discrimination on any level will not be tolerated. Once a safe environment has been established, clinicians are urged to dialogue with patients about the possibility of recent sociopolitical events that may have caused any stress, anxiety, or depression.
The article also suggests that clinicians educate themselves on local and federal laws that may affect vulnerable populations, as well as the various local advocacy groups so as to better connect patients to community resilience resources and supportive services. It goes on to state that clinicians should consider taking a more active role in advocacy and policymaking within their immediate environments, such as engaging staff in cultural competency awareness and anti-stigma training, in addition to attending local community meetings on the health impact of social policies of marginalized groups.
Concluding with a message imploring the ongoing need for research assessing the effects of social climate change and public policy pertaining to emotional health and wellbeing, I find myself in state of reflection. The potentialities of a clinical profession in the year 2017; grappling the interconnectivity of today’s social fabric; focusing on providing essential care on a daily basis. I concede that this feels like a tremendous burden, certainly one that was not covered in academic course material. Thus, determining how we as clinicians activate this within ourselves and our practice is a decision each must come to on our own.
Healthcare Policies Are Inherently Political
This past May, The American Journal of Public Health considered how healthcare is inherently political, because healthcare laws and policies are determined by federal and state governments[v]. The article stressed the need for policy-targeted education through research by health professionals, with an insistence on more effective communication and strategies to combat public misinformation and politically motivated policies with serious consequences for the public’s health.
Among the strategies recommended: clearly stating core messages within published articles and blogs, review process findings for public healthcare policies should happen in real time when the policy is being debated, hyperlinks should be provided on social media directing readers to the full text of policy articles, and healthcare professionals should consider allowing blogs associated with public health and medical journals to reach a broader audience while targeting them toward political sites, cable news, and individual commentators.
In sum, today’s clinical-political climate is one that merits a high degree of consideration. Neutrality is a means to an end, though perhaps not the most effective way to handle our professional and therapeutic relationships.
The old adage of “don’t talk politics at work” is incongruent with the fact that healthcare is often guided by federal and state policies and laws, and thus, inherently political. Healthcare providers must utilize their scope of practice and skills to the degree with which each is comfortable, in order to gain a greater understanding of their patients.
If we strive toward more supportive judgment-free work and therapeutic environments and advocate for inclusive communities at large, we can work on healing, restoring or maintaining more than just the body of a patient, but the body of our interconnected society.
“No Politics, Please. Hospital Gym Tries to Lower the Stress.” Modern Healthcare, vol. 46, no. 45, 07 Nov. 2016, p. 0036. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=119388093&site=eds-live.
[ii] Weinstein, B. “The Ethics of Talking Politics at Work.” Podiatry Management, vol. 27, no. 8, Oct. 2008, pp. 61-62. EBSCOhost, search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105700826&site=eds-live.
[iii] Brouillette, Richard. “Why Therapists Should Talk Politics.”The New York Times, The New York Times, 15 Mar. 2016, mobile.nytimes.com/blogs/opinionator/2016/03/15/why-therapists-should-talk-politics/. Accessed 27 Aug. 2017.
[iv] Williams, David R., and Morgan M. Medlock. “Health Effects of Dramatic Societal Events — Ramifications of the Recent Presidential Election.”New England Journal of Medicine, vol. 376, no. 23, 8 June 2017, pp. 2295–2299., doi:10.1056/nejmms1702111.
[v] Grant, Roy. “Public Health Professionals Urgently Need to Develop More Effective Communications Strategies.” American Journal of Public Health, vol. 107, no. 5, May 2017, pp. 658-659. EBSCOhost, doi:10.2105/AJPH.2017.303738.