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Unless his core supporters are mainly the rich,I don't see how that's gonna help anybody....but his supporters are mainly the poor redneck trash from the southern states
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What did Trump do for the past 4 years as President?
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Unless his core supporters are mainly the rich,I don't see how that's gonna help anybody....but his supporters are mainly the poor redneck trash from the southern states
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Wow, you know who the supporters are? did you do a survey of them and ask them questions?
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This goes to core Republican values which encompasses both redneck and rich supporters like Robert Mercer and Betsey deVos.
Oh and SC rulings affect the whole American society.
I ain't no Trump fan but objectively this is a very big deal.
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How do these English trash like Hilton and Sebastian Gorsky land up in America?
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Just speak for yourself. You don't represent everyone here, you asshole.
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This has got to be the trashiest US presidential race in history. Both candidates are un-voteable.
Seriously.. whoever wins we lose
Seriously.. whoever wins we lose
He did not, in fact N Korea actually has bigger nukes now. It has actually made the situation worse.
You say Obama is not a good president, but why then is he ranked the #8 of all the 45 presidents so far?
https://en.wikipedia.org/wiki/Historical_rankings_of_presidents_of_the_United_States
Maybe it might come as a shock to you, that Trump is ranked dead last 44/45 of the presidents ever elected.
As a doctor, maybe the New England Journal of Medicine might give you some insights as to how the doctors/medical field views Donald J Trump?
https://www.npr.org/sections/corona...al-urges-americans-to-vote-trump-out-of-offic
In Rare Step, Esteemed Medical Journal Urges Voters To Oust Trump
October 8, 20201:19 PM ET
BILL CHAPPELL
"Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment," reads a New England Journal of Medicine editorial signed by some three dozen editors.
Michael Dwyer/AP
The Trump administration has "taken a crisis and turned it into a tragedy" in its response to the COVID-19 pandemic, The New England Journal of Medicine says in a scathing editorial that essentially calls on American voters to throw the president out of office.
It is the first time the prestigious medical journal has taken a stance on a U.S. presidential election since it was founded in 1812.
"When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent," reads the editorial signed by nearly three dozen of the journal's editors. "We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs."
The editors accuse Trump's government of a massive public health failure — and of worsening the pandemic's effects by prioritizing politics over sound medical guidance.
The piece, titled "Dying in a Leadership Vacuum" and published Wednesday, does not mention President Trump or his Democratic rival, Joe Biden, by name. But it refers to the Trump administration repeatedly, and its footnotes cite news articles about Trump insisting that coronavirus risks are overblown, pressuring federal scientists, and politicizing the search for treatments.
Article continues after sponsor message
"Instead of relying on expertise, the administration has turned to uninformed 'opinion leaders' and charlatans who obscure the truth and facilitate the promulgation of outright lies," the editorial states.
The New England Journal of Medicine is at least the third widely respected medical or science journal to call for a change in U.S. leadership. Editor-in-Chief Dr. Eric Rubin says the editorial is rare for two main reasons: It's one of the handful of times an editorial has been signed by all the editors, and it takes an unprecedented political stand.
"There have been many mistakes made that were not only foolish but reckless," Rubin tells CNN, "and I think we want people to realize that there are truths here, not just opinions."
Even though the U.S. has distinct advantages in biomedical research, manufacturing capacity and public health expertise compared with many other countries, the U.S. has recorded more than 212,000 deaths from the coronavirus — the most in the world. Along the way, U.S. leaders have denigrated experts and ceded disease control to the states, the journal's editors say.
"Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences," the editorial states. "Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment."
The editorial acknowledges the difficulties that all countries face in coping with the coronavirus. And it notes that some deaths are unavoidable in a pandemic. But in the U.S., the authors say, "we have failed at almost every step," from having adequate protective gear to a problematic approach to testing and contact tracing to a failure to follow basic precautions such as wearing face masks.
"In much of the country, people simply don't wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures," the editorial states.
Many of the sentiments echo concerns raised in other venerable journals this year.
Scientific American broke with 175 years of tradition by endorsing Biden last month – a decision that was both unanimous and quick, Editor-in-Chief Laura Helmuth told NPR. And The Lancet called on Americans to make Trump a one-term president back in May.
All three journals took stands against Trump without referring to political parties; Helmuth says the Scientific American editorial purposefully avoided doing so in an attempt to be inclusive for its readers.
In a similar vein, the New England Journal of Medicine editorial states, "Truth is neither liberal nor conservative."
The opinion piece notes that the U.S. has performed worse than many other developed nations, such as South Korea that had much higher rates of travel to and from China when the coronavirus initially emerged.
The journal's editors write: "The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000."
I know Trump has made hell of a lot of enemies and made a lot of people very angry with him. Which means that he has at least stood by something and is not a total crowd pleaser who switches in between whatever everyone says.
Such people make bad politicians.
You want those politicans say all the nice things do nothing and just talk cock sprinkle some pep talks here and there.
Such people make bad politicians.
You want those politicans say all the nice things do nothing and just talk cock sprinkle some pep talks here and there.
He did not, in fact N Korea actually has bigger nukes now. It has actually made the situation worse.
You say Obama is not a good president, but why then is he ranked the #8 of all the 45 presidents so far?
https://en.wikipedia.org/wiki/Historical_rankings_of_presidents_of_the_United_States
Maybe it might come as a shock to you, that Trump is ranked dead last 44/45 of the presidents ever elected.
As a doctor, maybe the New England Journal of Medicine might give you some insights as to how the doctors/medical field views Donald J Trump?
https://www.npr.org/sections/corona...al-urges-americans-to-vote-trump-out-of-offic
In Rare Step, Esteemed Medical Journal Urges Voters To Oust Trump
October 8, 20201:19 PM ET
BILL CHAPPELL
"Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment," reads a New England Journal of Medicine editorial signed by some three dozen editors.
Michael Dwyer/AP
The Trump administration has "taken a crisis and turned it into a tragedy" in its response to the COVID-19 pandemic, The New England Journal of Medicine says in a scathing editorial that essentially calls on American voters to throw the president out of office.
It is the first time the prestigious medical journal has taken a stance on a U.S. presidential election since it was founded in 1812.
"When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent," reads the editorial signed by nearly three dozen of the journal's editors. "We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs."
The editors accuse Trump's government of a massive public health failure — and of worsening the pandemic's effects by prioritizing politics over sound medical guidance.
The piece, titled "Dying in a Leadership Vacuum" and published Wednesday, does not mention President Trump or his Democratic rival, Joe Biden, by name. But it refers to the Trump administration repeatedly, and its footnotes cite news articles about Trump insisting that coronavirus risks are overblown, pressuring federal scientists, and politicizing the search for treatments.
Article continues after sponsor message
"Instead of relying on expertise, the administration has turned to uninformed 'opinion leaders' and charlatans who obscure the truth and facilitate the promulgation of outright lies," the editorial states.
The New England Journal of Medicine is at least the third widely respected medical or science journal to call for a change in U.S. leadership. Editor-in-Chief Dr. Eric Rubin says the editorial is rare for two main reasons: It's one of the handful of times an editorial has been signed by all the editors, and it takes an unprecedented political stand.
"There have been many mistakes made that were not only foolish but reckless," Rubin tells CNN, "and I think we want people to realize that there are truths here, not just opinions."
Even though the U.S. has distinct advantages in biomedical research, manufacturing capacity and public health expertise compared with many other countries, the U.S. has recorded more than 212,000 deaths from the coronavirus — the most in the world. Along the way, U.S. leaders have denigrated experts and ceded disease control to the states, the journal's editors say.
"Anyone else who recklessly squandered lives and money in this way would be suffering legal consequences," the editorial states. "Our leaders have largely claimed immunity for their actions. But this election gives us the power to render judgment."
The editorial acknowledges the difficulties that all countries face in coping with the coronavirus. And it notes that some deaths are unavoidable in a pandemic. But in the U.S., the authors say, "we have failed at almost every step," from having adequate protective gear to a problematic approach to testing and contact tracing to a failure to follow basic precautions such as wearing face masks.
"In much of the country, people simply don't wear masks, largely because our leaders have stated outright that masks are political tools rather than effective infection control measures," the editorial states.
Many of the sentiments echo concerns raised in other venerable journals this year.
Scientific American broke with 175 years of tradition by endorsing Biden last month – a decision that was both unanimous and quick, Editor-in-Chief Laura Helmuth told NPR. And The Lancet called on Americans to make Trump a one-term president back in May.
All three journals took stands against Trump without referring to political parties; Helmuth says the Scientific American editorial purposefully avoided doing so in an attempt to be inclusive for its readers.
In a similar vein, the New England Journal of Medicine editorial states, "Truth is neither liberal nor conservative."
The opinion piece notes that the U.S. has performed worse than many other developed nations, such as South Korea that had much higher rates of travel to and from China when the coronavirus initially emerged.
The journal's editors write: "The death rate in this country is more than double that of Canada, exceeds that of Japan, a country with a vulnerable and elderly population, by a factor of almost 50, and even dwarfs the rates in lower-middle-income countries, such as Vietnam, by a factor of almost 2000."
Actually I would say that is very unprofessional of the NEJM to comment on politics and take political positions.
We are told often NOT to talk about politics as professionals with our patients. It damages the relationship. What if your patient is a Trump supporter?
NEJM should keep their mouths and hands shut. Now there will be angry Trump supporters scolding doctors thinking ALL doctors are anti-Trump. Why do that?
https://www.medpagetoday.com/blogs/kevinmd/89004
Op-Ed: Should Politics Stay Taboo in the Exam Room?
— Doctors can educate patients about the health implications of their political choices
by Hayward Zwerling, MD October 7, 2020
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I walked into my exam room to see a patient I first met 2 decades ago. His medical problems included poorly controlled diabetes, hypertension, hyperlipidemia, and a substance abuse disorder. Over the years, our healthcare system has served him well as he has remained free of diabetic complications and now leads a productive life.
Watching this transformation has been both professionally rewarding and personally enjoyable, and I look forward to our periodic interactions.
At this visit, he was sporting a MAGA hat. I was confused. How can my patient, who has so clearly benefited from America's healthcare system, support a politician who has tried to abolish the Affordable Care Act, used the bully pulpit to undermine America's public health experts, refused to implement healthcare policies that would mitigate COVID-19's morbidity and mortality, and who minimizes the severity of the coronavirus pandemic every day?
Why does my patient support a politician whose healthcare policies are an immediate threat to his health and longevity?
My brain says, "You are the physician this patient trusts to take care of his medical problems. You must teach him that COVID-19 is a serious risk to his health and explain how the president's public health policies threaten his health. You must engage in a political conversation."
However, it is currently taboo for physicians to discuss politics in the exam room, especially when political opinions are discordant, as it risks creating a rift in the patient-physician relationship. Reflexively, I answer myself: "Do not engage in a political discussion. You need to deal with his immediate health issues."
During the visit, we reviewed his medicines and test results and agreed on a treatment plan. At the end of the visit, I told him that it is in his best health interest to wear a mask, socially distance, wash his hands frequently, and defer visiting his favorite bar and gym. I consciously decided not to address his support for the president.
Back in my office, I reviewed the encounter and immediately had misgivings about my decision to avoid discussing the health ramifications of his political proclivities. I knew he was mistakenly informed about the science of COVID-19, as his primary source of information was Fox News and his peers. I was concerned that this misunderstanding led him to support a politician whose public health policies will adversely impact his health.
Every day physicians teach their patients the scientific truths they must understand to enable them to make informed healthcare decisions. Is it not also a physician's responsibility to teach their patients the science underlying relevant public health policy and explain that there is a linear connection between political choices, public health policies, and their health and longevity?
Would not a more comprehensive understanding of this relationship enable our patients to make more informed political decisions, including the option to choose political leaders who will implement better healthcare policies?
While politics has become hyperpolarized, most patients still believe their physicians tell the truth about science and medicine; thus, physicians are in a unique position to educate their patients about the ramifications of science.
By selecting me as his physician, he was implicitly telling me that he had confidence in my judgment. In return, I should have emphasized that the coronavirus is an immediate risk to his health; I should have explained how COVID-19 spreads and how he can reduce his risk.
I probably should have breached the "no politics in the exam room" taboo and told him that the president's refusal to implement public health measures recommended by every public health expert has resulted in the needless death of tens of thousands of Americans and is part of the reason that 1,000 Americans die from COVID-19 every day. I should have explicitly connected the dots and stated that the President's COVID-19 public health policy is an immediate threat to my patient's health.
The medical profession now understands that social determinants of health are probably the most important driver of a patient's overall health, and these determinants are largely the result of political decisions.
Clearly, we have a professional responsibility to teach our patients the science underlying their health issues. Don't we also have a professional obligation to ensure that our patients understand the health ramifications of their political choices?
If that is the case, do we not have a professional obligation to initiate a conversation about the political issues that impact our patients' health?
If we fail to breach the taboo of "talking politics" in the exam room, are we not shirking our professional responsibilities to our patients and society?
Hayward Zwerling, MD, is an endocrinologist who blogs at I Have an Idea.
This post appeared on KevinMD.
https://acpinternist.org/archives/2013/09/presidents.htm
PRESIDENT'S MESSAGE | SEPTEMBER 2013
How to handle talking politics with patients
While physicians should not inflict their political opinions on patients, how this plays out in the exam room depends on the doctor.
By Molly Cooke, MD, FACP
Iwas seeing patients the other day when Mrs. T., a vigorous 78-year-old, recounted her visit with her orthopedic surgeon, who had recommended a revision of her hip replacement. She said, “I suppose that with Obamacare, I won't be able to get this.”
I asked her if the surgeon had told her that the Affordable Care Act would somehow complicate getting appropriate care under Medicare. “No, he didn't say anything about it,” she said. “It's just that it's all about rationing.”
Mrs. T. is a well-insured resident of one of the Bay Area's many prosperous communities. I also take care of her husband, and while I have never talked politics with either of them, I can guess their party affiliation. How should I have responded? Before I tell you how I did, I had to consider the background.
I like politics and have cared for patients through all kinds of politically fraught and fractious times. In October 1980, three months into my year as chief resident and a month after the founding of the labor union Solidarity in Gdansk, Poland, the housestaff at San Francisco General Hospital went on strike, protesting understaffing and outsourcing. The United States invaded Granada in 1983, ostensibly to protect American citizens, including medical students at St. George's University. 1998 saw the first impeachment proceedings against a sitting president since Andrew Johnson. There have been nine presidential elections since I earned my MD, including the contested election of 2000. Through all of this, I can't recall that I have ever initiated a political conversation with a patient; certainly, I have never worn a campaign button or otherwise advertised my political opinions.
There is a consensus that physicians should not inflict their political opinions on their patients. How this plays out in the exam room depends on the physician. Some demur when asked how they will vote, with a noncommittal phrase like “I always try to vote for the candidate who I believe is best for our community.”
However, this is not universal, as Suzanne Koven, MD, a primary care internist in Boston, described in a recent blog post. Part of this is a simple matter of business etiquette, as Dr. Koven points out. Why introduce extraneous content into the patient-physician relationship that has the potential to be divisive or alienating? I suspect that many patients feel the same way and that this is why, in my experience, direct questions about political affiliations and voting intentions are uncommon.
Of course, physicians have the same rights of free speech as anyone else, and they can and do endorse candidates for office, pieces of legislation and actions taken by government officials. In a post at the American Medical Association's Virtual Mentor website in 2011, Thomas Bledsoe, MD, FACP, and Grayson Armstrong, an ACP Medical Student Member, considered the case of a physician who makes a political advertisement in support of a state proposition that would deny educational services to undocumented immigrants and their noncitizen dependents. This is available online.
Noting that physicians have an obligation to provide “expert advice to society on matters of health” and to “advance public health, and encourage access to care for all individuals,” the authors question whether the hypothetical physician is exploiting his standing in his community and encouraging extrapolation of assumption of expertise beyond the borders of his medical training. Even when the domain of the doctor's opinion is more clearly medical, physicians may differ among themselves about whether a piece of legislation will, for example, advance public health.
Whether physicians have an obligation to be politically engaged has engendered more controversy. In a series of papers published in the Journal of the American Medical Association in 2004 and 2006, Russell Gruen, MBBS, PhD, and collaborators argued that, beyond their clinical responsibilities to individual patients, physicians have obligations of advocacy and public participation that extend to issues of access to care and the improvement of socioeconomic conditions that directly affect health.
While professional associations like the American College of Physicians characteristically encourage member engagement by hosting congressional visits, others have argued that public citizenship and political engagement should not be regarded as a professional obligation of physicians.
Dr. Hoven wonders whether medicine has become more politicized. I suppose to some extent it has. The Affordable Care Act placed the organization and financing of medical care in the middle of a vociferous and often rancorous debate, one that is particularly difficult because physicians themselves are significantly split.
However, this is not the first time this has happened. The passage of Medicare in 1965 provoked much of the same vitriol. A divisive debate in the young United States focused on whether it was appropriate for frontier states to have less rigorous standards for medical training, both to expand the workforce and to create opportunities for less educated young men to join the middle class.
And there have always been very political physicians, perhaps notably Benjamin Rush, the distinguished Philadelphia physician who was a delegate to the Continental Congress, a signer of the Declaration of Independence and an ardent and vocal abolitionist.
The College has strongly supported the Affordable Care Act and has worked with chapters to mobilize support for Medicaid expansion. Speaking as a physician, I have seen the Act help my patients. After President Obama signed the bill, California moved promptly to set up a high-risk pool. A patient of mine, relatively young but uninsurable because he is self-employed and has hypertension and atrial fibrillation, took advantage of the opportunity to get coverage. Within a matter of weeks, he was found on the floor with a fever and a petechial rash. After three weeks in the ICU and a bit of time in rehab, he has recovered completely from his meningococcemia and is back at work. His hospital bill, however, was close to $350,000, a ruinous amount had he not been insured.
With all this in mind, I spoke to Mrs. T., the patient in front of me.
“You will absolutely be able to get your hip revision,” I told Mrs. T. “Let's talk about what the Affordable Care Act will and won't do.”
PRESIDENT'S MESSAGE | SEPTEMBER 2013
How to handle talking politics with patients
While physicians should not inflict their political opinions on patients, how this plays out in the exam room depends on the doctor.
By Molly Cooke, MD, FACP
Iwas seeing patients the other day when Mrs. T., a vigorous 78-year-old, recounted her visit with her orthopedic surgeon, who had recommended a revision of her hip replacement. She said, “I suppose that with Obamacare, I won't be able to get this.”
I asked her if the surgeon had told her that the Affordable Care Act would somehow complicate getting appropriate care under Medicare. “No, he didn't say anything about it,” she said. “It's just that it's all about rationing.”
Mrs. T. is a well-insured resident of one of the Bay Area's many prosperous communities. I also take care of her husband, and while I have never talked politics with either of them, I can guess their party affiliation. How should I have responded? Before I tell you how I did, I had to consider the background.
I like politics and have cared for patients through all kinds of politically fraught and fractious times. In October 1980, three months into my year as chief resident and a month after the founding of the labor union Solidarity in Gdansk, Poland, the housestaff at San Francisco General Hospital went on strike, protesting understaffing and outsourcing. The United States invaded Granada in 1983, ostensibly to protect American citizens, including medical students at St. George's University. 1998 saw the first impeachment proceedings against a sitting president since Andrew Johnson. There have been nine presidential elections since I earned my MD, including the contested election of 2000. Through all of this, I can't recall that I have ever initiated a political conversation with a patient; certainly, I have never worn a campaign button or otherwise advertised my political opinions.
There is a consensus that physicians should not inflict their political opinions on their patients. How this plays out in the exam room depends on the physician. Some demur when asked how they will vote, with a noncommittal phrase like “I always try to vote for the candidate who I believe is best for our community.”
However, this is not universal, as Suzanne Koven, MD, a primary care internist in Boston, described in a recent blog post. Part of this is a simple matter of business etiquette, as Dr. Koven points out. Why introduce extraneous content into the patient-physician relationship that has the potential to be divisive or alienating? I suspect that many patients feel the same way and that this is why, in my experience, direct questions about political affiliations and voting intentions are uncommon.
Of course, physicians have the same rights of free speech as anyone else, and they can and do endorse candidates for office, pieces of legislation and actions taken by government officials. In a post at the American Medical Association's Virtual Mentor website in 2011, Thomas Bledsoe, MD, FACP, and Grayson Armstrong, an ACP Medical Student Member, considered the case of a physician who makes a political advertisement in support of a state proposition that would deny educational services to undocumented immigrants and their noncitizen dependents. This is available online.
Noting that physicians have an obligation to provide “expert advice to society on matters of health” and to “advance public health, and encourage access to care for all individuals,” the authors question whether the hypothetical physician is exploiting his standing in his community and encouraging extrapolation of assumption of expertise beyond the borders of his medical training. Even when the domain of the doctor's opinion is more clearly medical, physicians may differ among themselves about whether a piece of legislation will, for example, advance public health.
Whether physicians have an obligation to be politically engaged has engendered more controversy. In a series of papers published in the Journal of the American Medical Association in 2004 and 2006, Russell Gruen, MBBS, PhD, and collaborators argued that, beyond their clinical responsibilities to individual patients, physicians have obligations of advocacy and public participation that extend to issues of access to care and the improvement of socioeconomic conditions that directly affect health.
While professional associations like the American College of Physicians characteristically encourage member engagement by hosting congressional visits, others have argued that public citizenship and political engagement should not be regarded as a professional obligation of physicians.
Dr. Hoven wonders whether medicine has become more politicized. I suppose to some extent it has. The Affordable Care Act placed the organization and financing of medical care in the middle of a vociferous and often rancorous debate, one that is particularly difficult because physicians themselves are significantly split.
However, this is not the first time this has happened. The passage of Medicare in 1965 provoked much of the same vitriol. A divisive debate in the young United States focused on whether it was appropriate for frontier states to have less rigorous standards for medical training, both to expand the workforce and to create opportunities for less educated young men to join the middle class.
And there have always been very political physicians, perhaps notably Benjamin Rush, the distinguished Philadelphia physician who was a delegate to the Continental Congress, a signer of the Declaration of Independence and an ardent and vocal abolitionist.
The College has strongly supported the Affordable Care Act and has worked with chapters to mobilize support for Medicaid expansion. Speaking as a physician, I have seen the Act help my patients. After President Obama signed the bill, California moved promptly to set up a high-risk pool. A patient of mine, relatively young but uninsurable because he is self-employed and has hypertension and atrial fibrillation, took advantage of the opportunity to get coverage. Within a matter of weeks, he was found on the floor with a fever and a petechial rash. After three weeks in the ICU and a bit of time in rehab, he has recovered completely from his meningococcemia and is back at work. His hospital bill, however, was close to $350,000, a ruinous amount had he not been insured.
With all this in mind, I spoke to Mrs. T., the patient in front of me.
“You will absolutely be able to get your hip revision,” I told Mrs. T. “Let's talk about what the Affordable Care Act will and won't do.”
https://www.ama-assn.org/delivering...nd-politics-what-ama-code-medical-ethics-says
Patients and politics: What the AMA Code of Medical Ethics says
JAN 4, 2018
Kevin B. O'Reilly
News Editor
With the dawn of a midterm election year and major issues affecting the nation’s health system on the agenda, questions arise about the role physicians should play in discussing political topics with patients.
In a recent JAMA opinion essay, Harvard Medical School Professor Jerry Avorn, MD, argued that “a strong case can be made that rather than being a taboo subject, discussing transformational changes in health care coverage with patients could be seen as a core responsibility of all clinicians—physicians, nurses, pharmacists, therapists.”
Such communications are “necessary to ensure the capacity of health care professionals to continue to provide patients with the health care they seek from us,” he added. “The intimate connection between coverage and clinical care also offers a direct and unassailable way to communicate this information.”
The AMA Code of Medical Ethics has guidance for physicians on this sensitive issue.
What the Code says
In Opinion 2.3.4, “Political Communications,” the Code explains:
The AMA Code of Medical Ethics also offers guidance on other aspects of patient-physician relationships, such as political action by physicians, gifts from patients and physician exercise of conscience.
A continuing medical education module incorporates animation, infographics and scenario-based learning to help physicians identify and understand how to maintain proper boundaries with their patients and to articulate and understand the underlying importance of those boundaries to the practice of medicine. The AMA has designated this enduring activity for 1 AMA PRA Category 1 Credit™.
The AMA Code of Medical Ethics is updated periodically to address the changing conditions of medicine. The new edition is the culmination of an eight-year project to comprehensively review, update and reorganize guidance to ensure that the Code remains timely and easy to use for physicians in teaching and in practice.
So NEJM SHOULD SHUT THE FUCK UP! Regardless who they support. Trump or Biden. Right or left. Rep or Dem. Just stay out of it!
The NEJM editors should be called up the the medical boards and disciplined.
Patients and politics: What the AMA Code of Medical Ethics says
JAN 4, 2018
Kevin B. O'Reilly
News Editor
With the dawn of a midterm election year and major issues affecting the nation’s health system on the agenda, questions arise about the role physicians should play in discussing political topics with patients.
In a recent JAMA opinion essay, Harvard Medical School Professor Jerry Avorn, MD, argued that “a strong case can be made that rather than being a taboo subject, discussing transformational changes in health care coverage with patients could be seen as a core responsibility of all clinicians—physicians, nurses, pharmacists, therapists.”
Such communications are “necessary to ensure the capacity of health care professionals to continue to provide patients with the health care they seek from us,” he added. “The intimate connection between coverage and clinical care also offers a direct and unassailable way to communicate this information.”
The AMA Code of Medical Ethics has guidance for physicians on this sensitive issue.
What the Code says
In Opinion 2.3.4, “Political Communications,” the Code explains:
More go-to guidance
The AMA Code of Medical Ethics also offers guidance on other aspects of patient-physician relationships, such as political action by physicians, gifts from patients and physician exercise of conscience.
A continuing medical education module incorporates animation, infographics and scenario-based learning to help physicians identify and understand how to maintain proper boundaries with their patients and to articulate and understand the underlying importance of those boundaries to the practice of medicine. The AMA has designated this enduring activity for 1 AMA PRA Category 1 Credit™.
The AMA Code of Medical Ethics is updated periodically to address the changing conditions of medicine. The new edition is the culmination of an eight-year project to comprehensively review, update and reorganize guidance to ensure that the Code remains timely and easy to use for physicians in teaching and in practice.
So NEJM SHOULD SHUT THE FUCK UP! Regardless who they support. Trump or Biden. Right or left. Rep or Dem. Just stay out of it!
The NEJM editors should be called up the the medical boards and disciplined.
https://journalofethics.ama-assn.org/article/political-discussions-exam-room/2011-11
Political Discussions in the Exam Room
Jack P. Freer, MD
Citation
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Case
Dr. Buccarelli is already behind schedule when he encounters his next patient, Mr. Van Ware. Mr. Van Ware is coming in for a follow-up appointment after a lingering, viral URI that finally resolved. He is politically engaged and has been following the Affordable Care Act legislation closely. His own insurance premiums have risen, and he asks what Dr. Buccarelli thinks of the individual mandate for health insurance.
“You think it’s fair that a young, healthy guy like me should be shouldering the bill for chronic care for the elderly?” Mr. Van Ware asks. Dr. Buccarelli replies in a general way that the current health system has its flaws and he is just happy that legislators are attempting to address the problems. Unsatisfied, Mr. Van Ware repeats his question about young people subsidizing older people’s expensive end-of-life care.
After a couple back-and-forths, in which Dr. Buccarelli politely explains that the ACA is 2,000 pages long and very complicated and that it will be years before the regulations are ironed out, Mr. Van Ware says, “Seriously, Doctor. You must know more about this new act than I do. Do you think the mandate that all of us, healthy or not, have to buy insurance is constitutional? Isn’t it socialism?”
Dr. Buccarelli considers all the answers he can offer Mr. Van Ware (who seems to have forgotten that, young healthy man that he is, he has had a serious URI for several weeks). Dr. Buccarelli feels his clinician’s role conflicting with his educator’s role and, meantime, his waiting room continues to fill.
Commentary
Dr. Buccarelli’s predicament is familiar to physicians who have spent any time in ambulatory clinical care. Falling behind schedule is annoying to patients and aggravating to doctors. Mr. Van Ware, with his resolving URI, ought to be an easy opportunity to catch up a little. Instead, patients often surprise us with unexpected symptoms or (as in this case) an urgent need to talk about current events.
Educating patients is an important part of practicing medicine. Aside from clinically relevant teaching that concerns the patient’s own condition, physicians have a broader role to share their unique perspective and knowledge with the public. Certainly, physicians have an inside track about health policy and health care reform. And yet, Mr. Van Ware may not be asking for Dr. Buccarelli’s opinion as much as he is grandstanding and debating an issue dear to his heart. He may be simply broadcasting his opinion to a captive audience (an opinion that is unlikely to change, no matter what Dr. Buccarelli says). Having attempted a polite diversion, Dr. Buccarelli can either address the issue or unequivocally notify the patient that the discussion is over. Giving Mr. Van Ware the benefit of the doubt, it may be that he is truly interested in his physician’s views. In that case, Dr. Buccarelli should have a few tight, informed comments to make about this important public policy issue directly related to medical practice.
Health insurance is a gamble, a bet. In a sense, you are betting that you willget sick or injured. If you “lose” the bet, you lose your wager (the insurance premium). If you “win” the bet, your payoff is that the cost of your medical care (or a very large part of it) is covered. Even young, healthy Mr. Van Ware can get hit by a dump truck running a stop sign later today and wind up being the recipient of several thousand dollars’ worth of medical care before the month is out. Groups like the Amish recognize health insurance as gambling and reject it. Interestingly, the ACA contains a religious exemption [1]. Although not specified in the law, many feel that Anabaptists (Amish, Mennonites, Hutterites) and Muslims might qualify under this provision [2].
Emergency medical care is already provided to the uninsured, and the costs are shared by others in society. When Mr. Van Ware gets hit by that dump truck, he will be taken to a hospital and treated, regardless of whether he has insurance. The Emergency Medical Treatment and Active Labor Act, EMTALA, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA), requires hospitals to provide emergency care regardless of insurance coverage or ability to pay [3]. If Mr. Van Ware were given the choice to opt out of insurance coverage altogether, society would still share the cost of his care. Fortunately, we do not live in a society that allows uninsured people to die for lack of treatment. So, whether Mr. Van Ware realizes it or not, young, healthy, intact people already pay for the care of the old, sick, and injured. Costs are shifted to the government through taxes as well as higher insurance premiums across the board.
Universal coverage is more efficient and economical. In 2004, more than $40 billion in medical care to the uninsured was uncompensated [4]. The majority of this care was provided by hospitals. These losses are offset by government in the form of disproportionate share hospital (DSH) payments. Hospital care to the uninsured is fundamentally inefficient; it is emergency care, late in the course of an illness rather than preventive care earlier, when it is more effective. However one calculates the economic costs of caring for the uninsured (due to uncompensated, late, or forgone care), it is more than the cost of insuring them.
The current health care system is financially unsustainable. The American health care system has grown in unbridled fashion for years. Gaining control over this sprawling system is the first step in slowing and reversing cost escalation. Analysts may disagree about the best way to gain control. While not perfect, the ACA is expected to make a significant difference [5].
While physicians may want to have some prepared sound bites in response to common questions, they ought to have a deeper knowledge of some of the underlying issues. Clearly this issue is extraordinarily complex and the details can be mind-numbing. Still, there are some valuable resources that can be accessed easily through the Internet. The Henry J. Kaiser Family Foundation has prepared a number of excellent analyses of health care reform and financing issues [6, 7], the federal government has a useful website on the subject [8], and HealthCareAndYou.org is an authoritative site sponsored by several organizations, including AMA, AARP, AAFP, and ACP [9].
Finally, there is another issue that could arise in this situation. When people display strong opinions about social and political issues, there is often the potential for the discussion to become heated and personal. The doctor’s office is no exception. In this setting, however, there is a real concern about professionalism and the patient-doctor relationship. Physicians must continually be aware of their place in relation to the patient. Ordinarily, the patient is not the doctor’s buddy. In fact, preexisting friendships put considerable strain on a clinical relationship. When professional relationships get blurred with personal ties, both can suffer. The friendship can be strained when the patient is unhappy with the doctor’s decision. Equally problematic is the way in which professional decision making can be compromised with a patient-friend. While not as striking as when caring for family members, the medical decisions made for friends can be similarly distorted.
When political discussions take a bad turn in a friendship, people can just drift away, but what about a patient-doctor relationship? Suppose you hear what sounds like racial bias (or even a blatant racial slur) in a political diatribe [10]. Does it affect your attitude toward that patient and can you objectively provide care for that person any longer? What does it say about how someone views you when he or she feels comfortable saying hateful things to you? Of course, a patient who resists more subtle suggestions that political debates or speeches are off limits, may need to be told directly that the professional relationship cannot continue without a limit on that behavior.
When both parties understand their roles, many aspects of the relationship can be presumed and go unsaid. In some situations, however, the terms must be explicitly restated. When that happens, honesty, transparency, and clarity are required to keep things on track.
READ MORE
REFERENCES
Virtual Mentor. 2011;13(11):753-756.
DOI
10.1001/virtualmentor.2011.13.11.ccas1-1111.
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
AUTHOR INFORMATION
We invite submission of manuscripts for peer review on upcoming theme issues.
UPCOMING THEMESYOU MAY ALSO BE INTERESTED IN
JAN 2004
Campaign Posters in the Clinic, Commentary 1
Marion Danis, MD
JAN 2004
Campaign Posters in the Clinic, Commentary 2
Leonard M. Fleck, PhD
OCT 2011
Physicians and Political Advocacy, Commentary 1
Thomas A. Bledsoe, MD
OCT 2011
Physicians and Political Advocacy, Commentary 2
Political Discussions in the Exam Room
Jack P. Freer, MD
Citation
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Case
Dr. Buccarelli is already behind schedule when he encounters his next patient, Mr. Van Ware. Mr. Van Ware is coming in for a follow-up appointment after a lingering, viral URI that finally resolved. He is politically engaged and has been following the Affordable Care Act legislation closely. His own insurance premiums have risen, and he asks what Dr. Buccarelli thinks of the individual mandate for health insurance.
“You think it’s fair that a young, healthy guy like me should be shouldering the bill for chronic care for the elderly?” Mr. Van Ware asks. Dr. Buccarelli replies in a general way that the current health system has its flaws and he is just happy that legislators are attempting to address the problems. Unsatisfied, Mr. Van Ware repeats his question about young people subsidizing older people’s expensive end-of-life care.
After a couple back-and-forths, in which Dr. Buccarelli politely explains that the ACA is 2,000 pages long and very complicated and that it will be years before the regulations are ironed out, Mr. Van Ware says, “Seriously, Doctor. You must know more about this new act than I do. Do you think the mandate that all of us, healthy or not, have to buy insurance is constitutional? Isn’t it socialism?”
Dr. Buccarelli considers all the answers he can offer Mr. Van Ware (who seems to have forgotten that, young healthy man that he is, he has had a serious URI for several weeks). Dr. Buccarelli feels his clinician’s role conflicting with his educator’s role and, meantime, his waiting room continues to fill.
Commentary
Dr. Buccarelli’s predicament is familiar to physicians who have spent any time in ambulatory clinical care. Falling behind schedule is annoying to patients and aggravating to doctors. Mr. Van Ware, with his resolving URI, ought to be an easy opportunity to catch up a little. Instead, patients often surprise us with unexpected symptoms or (as in this case) an urgent need to talk about current events.
Educating patients is an important part of practicing medicine. Aside from clinically relevant teaching that concerns the patient’s own condition, physicians have a broader role to share their unique perspective and knowledge with the public. Certainly, physicians have an inside track about health policy and health care reform. And yet, Mr. Van Ware may not be asking for Dr. Buccarelli’s opinion as much as he is grandstanding and debating an issue dear to his heart. He may be simply broadcasting his opinion to a captive audience (an opinion that is unlikely to change, no matter what Dr. Buccarelli says). Having attempted a polite diversion, Dr. Buccarelli can either address the issue or unequivocally notify the patient that the discussion is over. Giving Mr. Van Ware the benefit of the doubt, it may be that he is truly interested in his physician’s views. In that case, Dr. Buccarelli should have a few tight, informed comments to make about this important public policy issue directly related to medical practice.
Health insurance is a gamble, a bet. In a sense, you are betting that you willget sick or injured. If you “lose” the bet, you lose your wager (the insurance premium). If you “win” the bet, your payoff is that the cost of your medical care (or a very large part of it) is covered. Even young, healthy Mr. Van Ware can get hit by a dump truck running a stop sign later today and wind up being the recipient of several thousand dollars’ worth of medical care before the month is out. Groups like the Amish recognize health insurance as gambling and reject it. Interestingly, the ACA contains a religious exemption [1]. Although not specified in the law, many feel that Anabaptists (Amish, Mennonites, Hutterites) and Muslims might qualify under this provision [2].
Emergency medical care is already provided to the uninsured, and the costs are shared by others in society. When Mr. Van Ware gets hit by that dump truck, he will be taken to a hospital and treated, regardless of whether he has insurance. The Emergency Medical Treatment and Active Labor Act, EMTALA, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA), requires hospitals to provide emergency care regardless of insurance coverage or ability to pay [3]. If Mr. Van Ware were given the choice to opt out of insurance coverage altogether, society would still share the cost of his care. Fortunately, we do not live in a society that allows uninsured people to die for lack of treatment. So, whether Mr. Van Ware realizes it or not, young, healthy, intact people already pay for the care of the old, sick, and injured. Costs are shifted to the government through taxes as well as higher insurance premiums across the board.
Universal coverage is more efficient and economical. In 2004, more than $40 billion in medical care to the uninsured was uncompensated [4]. The majority of this care was provided by hospitals. These losses are offset by government in the form of disproportionate share hospital (DSH) payments. Hospital care to the uninsured is fundamentally inefficient; it is emergency care, late in the course of an illness rather than preventive care earlier, when it is more effective. However one calculates the economic costs of caring for the uninsured (due to uncompensated, late, or forgone care), it is more than the cost of insuring them.
The current health care system is financially unsustainable. The American health care system has grown in unbridled fashion for years. Gaining control over this sprawling system is the first step in slowing and reversing cost escalation. Analysts may disagree about the best way to gain control. While not perfect, the ACA is expected to make a significant difference [5].
While physicians may want to have some prepared sound bites in response to common questions, they ought to have a deeper knowledge of some of the underlying issues. Clearly this issue is extraordinarily complex and the details can be mind-numbing. Still, there are some valuable resources that can be accessed easily through the Internet. The Henry J. Kaiser Family Foundation has prepared a number of excellent analyses of health care reform and financing issues [6, 7], the federal government has a useful website on the subject [8], and HealthCareAndYou.org is an authoritative site sponsored by several organizations, including AMA, AARP, AAFP, and ACP [9].
Finally, there is another issue that could arise in this situation. When people display strong opinions about social and political issues, there is often the potential for the discussion to become heated and personal. The doctor’s office is no exception. In this setting, however, there is a real concern about professionalism and the patient-doctor relationship. Physicians must continually be aware of their place in relation to the patient. Ordinarily, the patient is not the doctor’s buddy. In fact, preexisting friendships put considerable strain on a clinical relationship. When professional relationships get blurred with personal ties, both can suffer. The friendship can be strained when the patient is unhappy with the doctor’s decision. Equally problematic is the way in which professional decision making can be compromised with a patient-friend. While not as striking as when caring for family members, the medical decisions made for friends can be similarly distorted.
When political discussions take a bad turn in a friendship, people can just drift away, but what about a patient-doctor relationship? Suppose you hear what sounds like racial bias (or even a blatant racial slur) in a political diatribe [10]. Does it affect your attitude toward that patient and can you objectively provide care for that person any longer? What does it say about how someone views you when he or she feels comfortable saying hateful things to you? Of course, a patient who resists more subtle suggestions that political debates or speeches are off limits, may need to be told directly that the professional relationship cannot continue without a limit on that behavior.
When both parties understand their roles, many aspects of the relationship can be presumed and go unsaid. In some situations, however, the terms must be explicitly restated. When that happens, honesty, transparency, and clarity are required to keep things on track.
READ MORE
REFERENCES
- Exemptions from Individual Responsibility Requirements. Patient Protection and Affordable Care Act, sec 1411(b)(5)(A). http://docs.house.gov/energycommerce/ppacacon.pdf. Accessed October 4, 2011.
- National Committee For Amish Religious Freedom. Amish FAQ general information. http://www.holycrosslivonia.org/amish/amishfaq.htm. Accessed October 3, 2011.
- Centers for Medicare and Medicaid Services. EMTALA. https://www.cms.gov/emtala/. Accessed October 3, 2011.
- Hadley J, Holahan J. The cost of care for the uninsured: what do we spend, who pays, and what would full coverage add to medical spending? The Kaiser Commission on Medicaid and the Uninsured. http://www.kff.org/uninsured/upload...uld-Full-Coverage-Add-to-Medical-Spending.pdf. Accessed October 3, 2011.
- Orszag PR, Emanuel EJ. Health care reform and cost control. N Engl J Med. 2010;363(7):601-603.
View Article PubMed Google Scholar - Henry J. Kaiser Family Foundation web site. http://www.kff.org. Accessed October 17, 2011.
- Henry J. Kaiser Family Foundation. Health Reform Source. http://healthreform.kff.org. Accessed October 17, 2011.
- US Department of Health and Human Services. HealthCare.gov website. http://www.healthcare.gov. Accessed October 17, 2011.
- Health Care and You. What the Affordable Care Act means for you. http://www.healthcareandyou.org. Accessed October 17, 2011.
- Capozzi JD. Rhodes R. Coping with racism in a patient. J Bone Joint Surg. (2006);88(11):2543-2544. http://www.jbjs.org/article.aspx?Volume=88&page=2543. Accessed October 17, 2011.
Virtual Mentor. 2011;13(11):753-756.
DOI
10.1001/virtualmentor.2011.13.11.ccas1-1111.
The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.
AUTHOR INFORMATION
- Jack P. Freer, MD is a professor of medicine, clinical professor of social and preventive medicine, and chief of the Division of Palliative Medicine at the University at Buffalo (SUNY) in New York. Dr. Freer is certified in hospice and palliative medicine, and his primary area of academic interest is communication skills.
We invite submission of manuscripts for peer review on upcoming theme issues.
UPCOMING THEMESYOU MAY ALSO BE INTERESTED IN
JAN 2004
Campaign Posters in the Clinic, Commentary 1
Marion Danis, MD
JAN 2004
Campaign Posters in the Clinic, Commentary 2
Leonard M. Fleck, PhD
OCT 2011
Physicians and Political Advocacy, Commentary 1
Thomas A. Bledsoe, MD
OCT 2011
Physicians and Political Advocacy, Commentary 2
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