On November 27, 2015, a horrific shooting at a Planned Parenthood clinic in Colorado Springs left three people dead. This tragedy is a stark reminder of the grave consequences that may accompany inflammatory political rhetoric and poor legislation. After his arrest, gunman Robert Dear declared “no more baby parts” to investigators. Dear’s terrifying actions have been linked to the national ongoing attack on reproductive rights as well as inadequate gun control laws. As a medical student, I fear that we will have many more Robert Dear’s in this country unless we make sure that political interests do not continue to impede on patient-provider relationships.
Horrific events like mass shootings or attacks on reproductive rights may in some ways be attributed to the increasingly limited ability of health care providers to educate and treat their patients. A report called “Politics in the Exam Room: A Growing Threat” released earlier this year describes how existing laws prevent doctors from executing their professional and ethical duties to provide evidence-based care to patients, cripple their ability to protect their patients and undermine the trust necessary for patient-provider relationships. The authors of the report focus on three issue areas: the clinical management of toxic exposures, reproductive health and gun safety.
Fracking uses many toxic chemicals, including a significant number of known or probable carcinogens. Yet, health care providers struggle to get information on such chemicals due to trade secret protections, thus preventing them from effectively treating patients who may have been exposed. And, even if providers are able to acquire the information on chemicals, they are prohibited from disclosing that information to anyone, including their patients. Such mandatory non-disclosure agreements preclude providers from openly discussing pertinent information with patients. This infringement undermines the autonomy of patients, which is deemed to be a vital component of patient-provider relationships by bioethicists such as Edmund Pellegrino. Mandatory non-disclosure agreements also hinder communication with consults and public health agencies, which may be necessary for optimal treatment of the patient.
Since 2010, various states have enacted more than 280 restrictions on abortion — a number that exceeds the total number of restrictions passed in the previous decade. Such restrictions include laws that require health care providers to provide information to their patients “that is inaccurate, biased, irrelevant or otherwise outside the medical profession’s standards of care, and therefore undermine true informed consent.” For instance, the report describes that in a dozen states, abortion providers are mandated to tell their patients that fetuses can feel pain even though such an assertion lacks a scientific basis. Other restrictions entail mandatory ultrasound or delay laws that coerce providers to go against their medical judgment when providing unnecessary care or withholding medical care altogether.
Various laws, such as “gag rules,” limit providers’ ability to counsel patients about gun safety, even though this is considered a standard practice for primary care physicians like pediatricians and family physicians. For instance, Florida recently passed a law in 2011 that prevents providers from even asking patients if they are gun owners. Authors of the report contend that, “health care providers routinely counsel their patients about a variety of hazards”; hence, “guns should be no different.” By impeding free communication between patients and providers, these laws prevent patients from accessing crucial health care information.
Implications for Medical Care and Training
Such restrictive laws hinder physicians’ ethical and professional duties to care for their patients, because that relationship is based on mutual trust and should reflect the most recent clinical evidence. They have significant national implications as well. According to the report, more than 15 million people live within one mile of a recently-drilled fracking well; one out of three women in the United States will have an abortion by age 45; and more than 100,000 people annually in the United States suffer from gunshot wounds while approximately 1.7 million children reside in homes with unsafe gun practices.
As a physician-in-training in the midst of learning how to conduct effective, patient-centered interviews, this is frightening. These laws go against many fundamental components of clinical practice that we are taught in medical school. We are constantly reminded of how vital trust is in patient-provider relationships. The importance of evidence-based medicine as a means of mitigating individual biases and providing the best care possible is also an essential part of our curriculum.
Unfortunately, these laws reinforce the need for medical students to not only be taught the essentials of physiology or anatomy, for instance, but also the tenets of advocacy. How can we make sure that progress in our profession isn’t hindered by special interests? Specifically, how can we maneuver our way thought the litigious landscape without compromising our morals or jobs? What steps can physicians take to tackle the more “upstream” factors of health so that they are not left feeling disempowered? How can the medical profession work with the communities we are entrusted to serve towards creating happier, health-optimal conditions for all?
There is indeed a growing recognition, among the physician community, of the need for sustainable community collaborations and inclusion of physician voices in policy making. Soon after the Planned Parenthood shooting and hours before another tragic mass shooting, a group of physicians delivered a petition to Congress urging them to eliminate the restriction imposed on the CDC that has prevented it from conducting research on gun violence.
To date, over five thousand health care providers and those in training from organizations such as the National Physicians Alliance and Doctors for America have signed this petition. Many Democrats have expressed their support to end the ban on gun-related research by targeting the spending bill in order to avoid a government shutdown. At the same time, former Republican Congressman Jay Dickey who had authored the amendment barring federal funding for gun violence research back in 1996, now reports to regret that decision and hopes that Congress will abolish the rule.
There is much work that needs to be done, but even as medical students, we can start pushing for necessary change right now, such as through curriculum reform, writing to inform and influence public opinion and participating in local and national advocacy days. Poor policies have a dual influence on clinical practice. They can yield conditions that hurt people’s health and they can directly interfere with clinical care that should be evidence-based and built on mutual trust. As seen in the recent Planned Parenthood shooting, actual lives are at stake. If physicians are removed of their shackles, we might just prevent yet another horrible tragedy.