Politics in practice: How to keep it professional when staff gets partisan

In a presidential election year, your office could be the site of political discussion and display. Here's how to avoid letting politics get in the way of patient care.

By Larry Stevens amednews correspondent — Posted March 10, 2008

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Politics not only may make strange bedfellows, but also could make enemies of normally cordial people. In this sometimes contentious political season, it is natural that doctors and staff might bring their political views into the workplace. Some even may wish to run for elective office.

The AMA and others say there's nothing wrong or unethical with doctors or staff supporting a candidate or running for office. Many believe that electing the right person could have a profound effect on health care and be as important to the patient population at large as clinical efforts are to individual patients. But how does a practice maintain individual rights to advocacy without creating divisions among staff, reducing morale and efficiency, and possibly even alienating patients?

The first question doctors must consider is whether and to what extent they will allow political advocacy in the work setting, experts say. The effect of political discourse at work can range from none to disruptive. Todd Dewett, a management consultant and a business professor at Wright State University in Dayton, Ohio, suggests not encouraging political discussion. "Talking about politics is good for democracy, but bad for the office."

Success in a medical practice depends on teamwork and collaboration -- which, Dewett says, could crumble when people take sides because of differing political points of view.

He adds that politics potentially decreases group decision-making capacity, because the habit of advocacy can carry over into nonpolitical discussions. And because advocacy has the potential of making people angry, the result may be sour faces and a reduction in the quality of listening. Finally, as a practical matter, Dewett says, "Any time spent talking politics, handing out pamphlets, etc., is time not spent caring for patients or doing office tasks."

In theory, if doctors want to, they can disallow all political discussion during working hours. Kevin Zwetsch, an attorney with Fowler White Boggs Banker in Tampa, Fla., explains doctors "have general rights to control the workplace and the activities the employees engage in at work." This includes what employees can talk about and even whether they can talk to each other at all. Zwetsch notes that doctors cannot restrict employees' right of free speech outside of work, and this extends to bumper stickers on cars parked outside.

But realistically, unless discussion of politics causes so many problems that physicians are willing to risk alienating staff in return for disallowing it, doctors will have to deal with at least some political advocacy at work, whether they like it or not.

"You might want to, but under most circumstances, you could never implement a total ban," says Nick Fabrizio, a consultant with the Englewood, Colo.-based Medical Group Management Assn. and a former practice administrator.

Fabrizio suggests that administrators or physicians treat instances of heated or disruptive political discussions on a case-by-case basis.

"There is no clear-cut line that you can draw between acceptable political discussion and unacceptable arguing," he says. But when administrators, managers or doctors believe that line has been crossed, they should discuss the problem with the primary offender. In most cases, that will solve the matter. Only if the problem is widespread and affects a large number of otherwise good workers should doctors try to ban all political talk, he says.

More subtle advocacy

There are other, less aggressive forms of advocacy -- wearing political pins, displaying small signs, offering bumper stickers. Jonathan Segal, an employment attorney with WolfBlock in Philadelphia, advises doctors to keep these passive forms of advocacy to a minimum. He warns that when employees display their support where patients can see it, there's the chance that someone will be offended.

Doctors who want to avoid an outright ban should consider imposing some ground rules regarding where employees can post political messages and how big buttons or posters can be, and disallowing negative political messages.

Aside from the potential for creating internal divisiveness and angering patients, overt political activity can have a deleterious effect on marketing efforts, according to DeAnne Merey, a public relations expert based in New York.

The problem does not have much to do with patients' political alliances, because few people consider political affiliation when selecting their doctors. But Merey says an office festooned with political paraphernalia might cause some patients to wonder if health care is really the group's primary objective. "I would not highlight any political activity in the office," she says, "since this may have the effect of turning away patients, even those patients who may agree with the cause but may feel that the office is distracted with priorities other than patient care."

On the other hand, Merey says political activity outside the practice can provide a marketing benefit. She says many people are happy to know their doctors are active in local or even national politics. Because doctors often are seen by local media as important community members, attending a rally for a local political figure or helping with a campaign could provide free publicity and name recognition for the doctor.

"Even if a doctor is just seen at a political event, this information may somehow find its way into an article or broadcast piece about the doctor or practice. Such media attention can be favorable for the practice," she says.

It's different for health care

While actively displaying support for a political figure or even a non-health care cause may be off-putting to patients, many believe doctors have every right to take positions on health care issues, and that patients won't penalize them for doing so.

In fact, some physicians -- laboring to provide quality care to the community despite a health care system they believe needs fixing -- feel it's their duty to educate patients about the issues.

"As a doctor who has been in practice for 25 years, it's sometimes hard to separate what I feel about our health care system from what I feel about treating patients," says Bernadette Sheridan, MD, a solo family physician in Brooklyn, N.Y.

Dr. Sheridan says she's been an outspoken supporter of the campaign of Democratic presidential contender Sen. Barack Obama. "Most everyone knows where I stand," she says. But she doesn't bring it to work.

She does encourage patients to contact politicians about problems with the high cost of medications or co-pay, or about their lack of health coverage.

She also will spend a few seconds laying out the issues. "I don't have a lot of time to talk health care policy with patients. But I am very willing to tell them what I believe in and leave it at that," she says.

Some experts say doctors who believe in specific health care issues can be more formal in their advocacy as long as they're not overly aggressive in pushing those beliefs on patients.

Says Matt Eventoff, president of PPS Associates, a communications consulting firm: "If you want to put fliers stating the changes you believe are necessary in health care near the magazine rack that patients can pick up voluntarily, that's fine. Just don't have your receptionist hand it out."

Doctors as politicians

When a doctor is the candidate, most experts suggest practicing the same restraint. Campaign posters hanging in the waiting rooms, signs on the lawn outside the practice or receptionists handing out campaign literature can alienate some patients to the extent that they will look for another doctor. But some patients do expect doctors running for public office to discuss their candidacy.

Charles Celano, MD, in solo practice at Indian River Cardiology in Vero Beach, Fla., is running in the Republican primary for a Florida House of Representatives seat.

Dr. Celano says he was a bit worried at first that his candidacy would adversely affect his practice, but not because he feared patients would disagree with his political stances. His concern was they would feel his potential new duties as legislator would prevent him from giving patients the attention they needed.

So his first step was to write to all his patients explaining that he still would be their doctor; that during his 12 weeks in the legislature, he would be covered by another doctor; and that, in any case, there would be no changes to the practice for about a year.

While the letter explained why he felt it was important for him to seek an elective position, "I was very careful not to solicit contributions or volunteers," he says. "The letter was a very basic statement of fact."

Dr. Celano will explain his views briefly to patients who specifically ask. But if any want to volunteer or make a contribution, he and his staff will generally just hand them the name and address of his campaign manager. "I keep my practice and my political goals as separate as I can."

When asked how he would handle an employee wearing a button for his opponent, he laughs and says, "I hope that wouldn't happen." But adds: "They have a right to the same free speech that I have. But they also have the same responsibility to keep political items out of the office, and certainly out of view of patients."

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Partisan conduct

Jonathan Segal, an employment attorney with WolfBlock in Philadelphia, suggests that physicians keep in mind at least the following points when deciding how to regulate political expression by staff. He says physicians are within their rights to put limits on any of these points:

  • The wearing of political buttons or display of political messages by employees in visible patient service.
  • Whether employees with offices may display political messages anywhere that can be seen from outside the immediate space.
  • Size limits on political signs.
  • Whether any material allowing the "trashing" of others is allowed.

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What the AMA says about political rights and responsibilities

The AMA House of Delegates in 1999 approved the following policy on physicians' political communications to patients and their families. It spells out that physicians are free to express themselves politically but must decide the most appropriate time or place to do so:

  • "Physicians enjoy the rights and privileges of free political speech shared by all Americans. It is laudable for physicians to run for political office; to lobby for political positions, parties or candidates; and in every other way to exercise the full scope of their political rights as citizens. These rights may be exercised individually or through involvement with organizations such as professional societies and political action committees.
  • "In addition, physicians have a responsibility to work for the reform of, and to press for the proper administration of, laws that are related to health care. Physicians should keep themselves well-informed as to current political questions regarding needed and proposed changes to laws concerning such issues as access to health care, quality of health care services, scope of medical research, and promotion of public health.
  • "It is natural that in fulfilling these political responsibilities, physicians will express their views to patients or their families. However, communications by telephone or other modalities with patients and their families about political matters must be conducted with the utmost sensitivity to patients' vulnerability and desire for privacy. Conversations about political matters are not appropriate at times when patients or families are emotionally pressured by significant medical circumstances. Physicians are best able to judge both the intrusiveness of the discussion and the patient's level of comfort.
  • "In general, when conversation with the patient or family concerning social, civic or recreational matters is acceptable, discussion of items of political import may be appropriate. Under no circumstances should physicians allow their differences with patients or their families about political matters to interfere with the delivery of high-quality professional care."

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