The Doctor Will Lecture You Now

Apparently, my patients have a condition I should be documenting: insufficient political agreement with the treating physician. The treatment will be a bedside lecture. No time to discuss your brain tumor; we must talk politics.

Better than a yard sign or a “we are worried about you!” spam text, the white coat is a great vehicle for reaching voters.

That is the invitation in Jerry Avorn’s MedPage Today essay on politics in the patient encounter. He suggests that clinicians begin discussions with patients regarding federal budget reductions in coverage to describe the impending harm and encourage them to vote to correct what has been done. He draws a parallel between the responsibility to warn a patient of a tumor or a dangerous arrhythmia. At last, a way to give our political opinions the authority of a cancer diagnosis.

Avorn says this need not involve directing patients to a particular candidate, but his political leanings are painfully obvious. Of course, it's unlikely anyone in his political bubble questions his sneering assertions. After all, only one side of the political spectrum actually cares about patients, public health, or basic human decency. The campaign message is just fine without even uttering a candidate’s name.

He even suggests placing this educational burden upon each patient’s active problem list. I envision the evaluation: Diabetes, Hypertension and a lack of appreciation for the potential electoral impact of the physician’s policy preferences. We are told that initiating these conversations is an ethical obligation. Clearly, it becomes easier to blur the lines between providing someone care and soliciting their support for your cause when you declare yourself the more righteous party.

But would Avorn extend the same ethical permission to a physician whose politics ran in the opposite direction?

“Mrs. Jones, I apologize that your insurance premium is so high. The Affordable Care Act mandates a wider array of benefits and prohibits insurers from charging prices based on medical risk. You may wish to consider the politicians who authored those decisions prior to voting. I would be remiss not to address such an important aspect of your care.”

Or consider a patient facing a long wait for an appointment. Surely a conservative physician could regard that as the ideal moment to explain California’s decision to spend state money expanding coverage to undocumented immigrants. A coverage dispute could prompt an equally earnest lecture about Medi-Cal paying for adult gender-transition procedures. Resources are finite; elections have consequences; how fortunate that your doctor is available to explain both.

An additional opportunity for enlightening bedside commentary exists within hospitals. A patient’s formerly independent specialist was purchased by a large, corporate hospital system. Now there’s a facility fee tacked on to the bill. Shall we explain that hospitals are the largest category of healthcare spending? Additionally, shouldn’t we discuss how federal policy generates economic advantages for hospitals owning medical facilities? Finally, can we point out how 340B programs generate profit for hospitals to acquire physician practices?

We could even mention Chuck Schumer’s April 2026 promise that hospitals would have “a seat at the table” under a future Democratic majority. He also opposed site-neutral payment cuts, and some of his Democratic colleagues advocate expanding 340B, which IQVIA estimates increases health-plan costs and puts upward pressure on insurance premiums. What an educational moment for a patient wondering whose interests healthcare policy serves. Perhaps we should hand out the hospital lobby’s seating chart with the after-visit summary.

Now imagine a future Congress enacts Medicare for All, replacing ordinary private coverage. Demand subsequently outstrips the system’s capacity, and a patient’s operation is delayed. Under Avorn’s proposed approach, a physician could offer the following helpful consultation:

“Mrs. Brown, I’m sorry your private insurance is gone. Congress prohibited insurers from offering coverage that duplicates the government plan. You have public coverage now, which drastically cut pay to doctors, prompting many to retire, decimating supply. Demand has outrun the available operating rooms and clinicians. Before the next election, you might ask which candidates supported taking away your old arrangement. I’m telling you this because I care about your health.”

The 2025 Medicare for All bill would prohibit private coverage, including employer coverage, once fully implemented. CBO’s illustrative single-payer analysis projects demand rising faster than supply, producing more congestion, delays, and forgone care.

Will Avorn embrace that conversation as an example of fulfilling the physician’s ethical obligations? Or would he characterize the tone as manipulative and reduce the conversation to an abuse of the patient’s vulnerability?

His own account of emergency-department crowding illustrates the problem with presenting political forecasts as clinical findings. He predicts a large influx of patients who lose insurance and consequently access to other care. Yet the randomized Oregon Medicaid experiment found that gaining coverage increased emergency-department use without advancing a tangible improvement in health outcomes. Several other studies show Medicaid patients face substantial obstacles in securing clinic appointments. It would be tough to fit the economic explanation into a standard 15-minute office visit, but I guess we doctors are obligated to try.

The AMA’s ethics guidance explicitly advises physicians to avoid initiating political conversations during clinical encounters because of patients’ vulnerability and the unequal relationship. Thus, I recommend a different hypothetical than Avorn’s guidance when dealing with a patient who understands your reasoning and acknowledges the trade-offs yet still disagrees with you. Will he continue to be viewed as a competent adult, or will the educational experience require another visit?

The holier-than-thou logic is hard to miss: Once the physician’s preferred politics are defined as the patient’s health interests, then opposing viewpoints are likely going to be seen as ignorance. It appears Avron can’t even fathom a world where intelligent, well-meaning people disagree with the downstream consequences of policies.

Patients disagree with me all the time. They disregard my recommendations, seek second opinions (which I encourage), and often actually do try to inject politics into our conversations. I always sidestep that in the exam room. A patient should not have to decide whether challenging my political sermon might make the person responsible for his care think less of him.

The patient came for medical help. If I want his vote, I can take off the white coat, leave the exam room, and make my argument where he is entirely free to walk away.