Doctors’ political views affect the advice they give patients on hot-topic health issues, study finds

The advice and care you receive from your doctor is likely to be influenced by his or her political beliefs, according to a study published this week in the Proceedings of the National Academy of Sciences (PNAS). 

Researchers at Yale University surveyed a national sample of primary care physicians (internists, general practitioners and family medicine providers) and found that patients receive significantly different care on several hot-button health related issues, such as marijuana use, gun safety and sexual behavior, depending on whether their physician is a Republican or a Democrat.

“Just as patients choose physicians of a certain gender to feel more comfortable, our study suggests they may want to make a similar calculation based on their doctor’s political views,” write the study’s authors, Eitan Hersh, an assistant professor of political science, and Dr. Matthew Goldenberg, a professor of psychiatry.

Support for the hypothesis

The two men believed their study might reveal such results. Previous research, they point out, has found that other demographic factors — gender, race and ethnicity, and region of the country — influence how doctors practice medicine.

In addition, Republican and Democratic physicians give much different ratings to the Affordable Care Act (ACA), and the percentage of physicians making political contributions has almost quadrupled since the early 1990s. 

Patient advocacy groups have taken notice. For example, the Human Rights Campaign, the largest gay-rights organization in the United States, has established a directory to help lesbian, gay, bisexual and transgender (LGBT) patients find LGBT-friendly doctors. The National Abortion Federation has a similar tool to help people find prolife doctors.

Study details

Using public voter registration databases, Hersh and Goldenberg linked political party affiliation to more than 20,000 primary care physicians in 29 states (the states where individuals register such affiliations). They then selected a representative sample of 1,529 of those physicians to survey. They focused only on Democrats and Republicans (rather than on independents), as answers from people closely aligned with the two major parties were the most likely to reveal differences in approaches to care. Only 233 of the physicians contacted completed the survey. (The researchers say this was most likely due to the fact that they did not offer any financial incentive for doing so.)

The survey presented nine hypothetical situations in which patients had health issues. Three dealt with “politically salient” issues: marijuana use, firearms in the house and abortion. The others dealt with issues not generally believed to be linked to political partisanship: alcohol use, sex with sex workers, tobacco use, the wearing of a motorcycle helmet, obesity and depression.

The scenarios presented either a healthy 38-year-old man or a healthy 28-year-old woman who’s visiting with the doctor for the first time. In the three hot-topic scenarios, the patient acknowledges (while providing a health history) that he or she:

• is a gun-owning parent with two small children at home;
• uses recreational marijuana approximately three times per week, but denies any related physical concerns;
• has had two elective abortions in the last five years, [but] denies any physical complaints or complications associated with those procedures [and] is not currently pregnant.

The physicians were asked to rate the seriousness of each scenario’s health issue (on a scale of 1 to 10) and to indicate their likelihood of engaging in specific treatments to address the patient’s situation.

Key results

The study found significant differences between Republican and Democratic physicians on the three politically salient topics. Democratic physicians were more concerned about the scenarios related to guns, while their Republican colleagues were more worried about the ones related to abortion and marijuana use. The differences added up to about 2.5 points for each of the issues on the 10-point “seriousness” scale. 

The differences held even after adjusting for gender, church attendance and the patients’ socioeconomic status.

How the doctors counseled their patients on these issues also fell along party lines.

On the issue of gun safety, the study found that Democratic physicians tended to advise patients to remove the guns from their homes, while their Republican counterparts were more likely to stress safe storage instead. (Several professional physician and other organizations, including the American Academy of Pediatrics, emphasize that “the best preventive measure against firearm injuries and deaths is not to own a gun.”)

When it came to abortion, the Republican physicians were more likely to consider the woman’s history of abortion a serious concern and to advise her that she should consider the mental health ramifications of the procedure. (In 2008, an American Psychological Association task force reviewed the existing scientific literature on this topic and concluded “there is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women.”)

When confronted with the marijuana scenario, the Republican physicians were more likely than their Democratic colleagues to discuss the drug’s health and legal risks and to urge the patient to cut down on its use — even though, as Hersh and Goldenberg point out, marijuana use presents “a lower associated health risk” to patients than do issues raised in several of the other scenarios whose seriousness the Republicans ranked lower.

A fourth scenario — one in which the patient acknowledges having sex with sex workers several times in the previous year — received similar seriousness rankings from both Democratic and Republican physicians. But the Republicans were more likely to discuss the associated legal risks and the impact such behavior could have on personal relationships.  

More awareness needed

This study has several limitations — most notably a 20 percent response rate. Also, the respondents are not perfectly representative of the country’s physicians, particularly since more Democrats than Republicans responded to the survey.

Yet, even with its limitations, “our study suggests that [patients] may need to be aware of their physician’s political worldview, especially if they need medical counsel on politically sensitive issues,” write Hersh and Goldenberg. 

The study also has a message for physicians, they add: “The evidence calls for heightened awareness and training surrounding treatment on politically salient issues. Given the politicization of certain health issues, it is imperative that physicians consider how their own political views may impact their professional judgments.” 

FMI: You’ll find an abstract of the study on the PNAS website, but the full study is behind a paywall.