The basic idea that doctors should be judged by the way they examine patients seems to have become outdated. Employers and the public are now trying to imply that unfavorable politics will inevitably lead to poor health care and discrimination.
A number of doctors have faced disciplinary action in recent months. For example, a Canadian resident named Yi-Pen Ge was suspended from his training program last year for sharing pro-Palestinian and anti-Israel content on social media. The university announced that the disciplinary action was taken in response to “alleged violations of professional standards.” (Mr. Ge has since been reinstated.) In the United States, New York University fired the director of its cancer center for anti-Palestinian social media posts at about the same time it fired a medical resident for pro-Palestinian posts. New York University justified its approach in the name of “providing a safe and inclusive environment.” Activists were more explicit about the relationship between politics and clinical practice: “Jewish patients, especially Israeli patients, should be kept away from this man,” one group said. I have written About trainees at New York University.
Each of these incidents involved extreme and divisive rhetoric, but we can be sure that it was sincerely intended. However, there has been no public evidence that these doctors’ positions on the Israel-Gaza war influenced the care they provided to their patients. New York University said that statements encouraging “Palestinian resistance” are “condoning hatred and violence” and are punishable. But I don’t think a doctor would be fired from a U.S. medical center for helping Ukrainians resist Russian aggression. Ukraine’s self-defense may be widely seen as legitimate, but its methods are certainly violent. We will not banish every doctor who adds the Ukrainian flag to his social media profile.
By raising the specter of “professionalism,” administrators connect taboo opinions with medicine. Physicians should always try to be resourceful. But professionalism is often just another word for conformity. The American Medical Association’s Code of Ethics warns doctors that online postings can “adversely affect your reputation among patients and colleagues” and “impact your medical career.” This is partially common sense. We have the right to free speech, but others have the right to think badly of us based on what we say. It is wise to avoid political topics at work. Still, shouldn’t a code of ethics emphasize what is right rather than professional expediency? Early in my career, I was advised not to be too open about the fact that I was gay. I was told that making patients and other doctors comfortable was a “matter of professionalism”. But pleasing everyone is a fool’s errand. Politics and religion often involve deep disagreements.
When someone else’s opinion deeply hurts us, the line between permissible and impermissible speech can seem clear. I used to live in a liberal enclave in New Haven. When Donald Trump won the 2016 election, his colleagues and I were predictably disappointed. Some of my friends have argued that doctors who voted for Trump are unfit to care for our nation’s patients, including many immigrants and racial minorities. Some readers may be nodding. But as far as I know, my friends didn’t actually try to get Republican doctors fired. That would set a dangerous precedent. Presumably, doctors in conservative areas were similarly offended by their colleagues who voted for Hillary Clinton. Attitudes toward Israel and Gaza may be equally strong and evenly divided.
Polarization aside, certain types of speech are unacceptable. Racist, sexist, and other bigoted language should be off-limits in medical settings. However, problems can arise when applying this basic rule to broader discussions. In 2020, a cardiologist named Norman Wang published an article in the Journal of the American Heart Association discussing the value of affirmative action in cardiology. Wang concluded that racial preferences in medical school admissions should be abandoned. “Long-term academic solutions and excellence should not be sacrificed for short-term demographic considerations,” he wrote. Wang’s essay was perceived by some doctors as racist. The journal quickly retracted the paper after an outcry on social media, and Wang was removed as director of the fellowship program. (He is suing over these events.)
Physicians must be sensitive to bias given the historical and ongoing injustices in the profession. But in this case, the peer-reviewed paper was essentially treated as hate speech advocating positions supported by a large portion of the population, including many people of color. The journal said scientific errors and misleading citations were the cause of the retraction. But it seems to me that policy debates are a contributing factor. The American Heart Association responded with an editorial, declaring it “unequivocally disagrees” with Wang’s views and supports the continuation of racial and ethnic admissions requirements.
Medicine has solved this problem for itself. The expert has encouraged doctors to speak out under the auspices of patient advocacy during President Trump and the pandemic. The argument was that medicine and public health are inherently political. Therefore, openly participating in political activities is an honest approach. But this mission was always contingent on shared politics. Before Mr. Geh, who lives in Canada, was suspended for his pro-Palestinian post, the university publicly praised him for his outspokenness. The school promoted the idea that “physicians can serve both as health care providers and as advocates for health equity and social justice.” Mr. Ge was also appointed to the board of directors of the Canadian Medical Association, but has now stepped down from that position. Activism is good! No, wait, that’s not true!
Doctors are allowed to have their own political and religious views. However, our first priority is to provide excellent medical care without discrimination. Nevertheless, I am beginning to believe that anti-gay doctors should be allowed to treat me if they can do it well. Physicians are trained to put aside their own emotions and ethical judgments as much as possible. We love hearing about Jewish doctors willing to treat Nazi patients. I admit that a homophobic doctor treating a homosexual patient may seem less admirable, but the general principle is the same. There is no reason why the sharp differences of opinion regarding the Middle East cannot be overcome. Healthcare providers should only intervene when personal beliefs compromise patient safety. Disappointing social media posts rarely meet that criteria.
The war in Gaza is undeniably tragic and morally ambiguous. It was predictable that a doctor’s comment on the conflict would cause problems. Of course, there were some doctors who went beyond polite conversation. But attacking every professional who spews controversial views publicly, or more often privately, will empty clinics and hospitals.
Benjamin Mather is a physician in Baltimore.