Does Political Affiliation Influence Patient Care? An Interview With Anupam B. Jena, MD

Political differences have been found to “spill over into nonpolitical domains,” with evidence suggesting that physicians are also increasingly polarized
Political differences have been found to “spill over into nonpolitical domains,” with evidence suggesting that physicians are also increasingly polarized

Political polarization is “the defining feature of early 21st century American politics.”1 A 2014 study conducted by the Pew Research Center1 found that Republicans and Democrats are “further apart ideologically than at any point in recent history” and that this polarization “goes beyond politics” and is reflected in the personal lives and lifestyles of those on both the right and left.

These divisions between Republicans and Democrats have grown even larger since Donald Trump's first year as president, and the “magnitude of these differences dwarfs other divisions in society, along such lines as gender, race and ethnicity, religious observance or education,” according to an updated 2017 Pew Report.2

Political differences have been found to “spill over into nonpolitical domains,” with evidence suggesting that physicians are also increasingly polarized3 and that physicians' political beliefs may predict their clinical decisions.4

A 2016 study of >20,000 primary care physicians (PCPs) from 29 states, linked physician records to their political affiliation (based on a voter registration database). A sample of Democratic and Republican PCPs was then surveyed to ascertain attitudes to 9 patient vignettes that addressed particularly politicized healthcare issues (marijuana, abortion, and firearm storage).4

Democratic and Republican physicians were found to “differ substantially in their expressed concern and recommended treatment plan” regarding these issues. The researchers concluded that “physician partisan bias can lead to unwarranted variation in patient care.”

A 2018 study3 offers a different perspective. While acknowledging the significant partisan gaps that affect physicians as well as others, the findings suggest that physician political affiliation is not associated with the intensity of end-of-life care received by patients in the hospital.

The researchers used a random sample of Medicare beneficiaries (N=1,480,808) who were hospitalized between 2008-2012 with a general medical condition and died in the hospital or shortly thereafter.

They examined total inpatient spending, intensive care unit (ICU) use, intensive end-of-life treatments among patients dying in the hospital, and hospice referrals among patients discharged but at high predicted risk of 30-day mortality after discharge.

The researchers characterized physicians as Democrat (N=1523), Republican (N=768), or non-donors (N=23,627), using federal contribution data.

They found that mean end-of-life spending as well as intensive end-of-life treatments for patients who died in the hospital did not vary by physician political affiliation. Similarly, the proportion of patients discharged from the hospital to hospice also did not vary between physicians of differing political affiliations.

To shed further light on the study's implications, MPR interviewed lead author Anupam B. Jena, MD, PhD, Ruth L. Newhouse Associate Professor, Harvard Medical School, Boston, MA.

[Continue to page 2 to read the interview...]