White Coat Underground

In the Soviet Union, party membership was everything. Your job, your access to food and other consumer goods, and your apartment all depended on your standing with the party. And votes were simply a tool to provide a patina of legitimacy. No one who liked warm weather voted against the Party.

One of the many advantages of the protections provided by the U.S. constitution is that we generally cannot be hired or fired based on our personal or political beliefs. We also get to elect our leaders frequently. So it should be with a great sense of irony that various teabagger groups shout and stomp about the US becoming a socialist regime, while simultaneously threatening armed rebellion for not getting their way in an election. And it is with disgust and disdain that I view professionals punishing others based on their vote or their political views.

When a physician fired an employee for voting for Obama, that was—I assume—a clearly illegal act. It was also immoral. But it has nothing to do with medical ethics.

But when a doctor refuses to see patients based on their politics, this is a gross violation of medical ethics. In fact, it’s hard to think of a precept of medical ethics not violated by this sort of behavior.

This has become an issued due to the widely-publicized story of Dr. Jack Cassell, a Florida urologist who posted a sign on his office door which said, “If you voted for Obama…seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years.” The doctor claims that he hasn’t turned anyone away, but that is irrelevant. The only person’s needs being served by the sign are his own—whether it is to make a political point, humiliate others, or who-knows-what-else. (The statement that he hasn’t turned anyone away is irrelevant for a number of reasons: first, he can’t know this, as the sign acts as his proxy, and second, even if no one leaves, they can be made to feel very uncomfortable.)

As a physician, Dr. Cassell’s first duty is to serve his patients.  He should not be forced to see any particular patient, but neither should he abandon patients or turn them away for arbitrary reasons.  Dr. Cassell is well within his constitutional and professional rights to choose whom he treats and what he says, but using patients to satisfy one’s own needs is both unethical and pathetic.  

Basic medical ethical principles, such as beneficence, non-maleficence, and dignity dictate that we not use patients to make our own political statements.  Dr. Cassell’s sign may deter current and future patients from seeking needed care, and may lead to abandonment, as patients of his who see the sign may feel unwelcome.  This may lead to feelings of humiliation and delay of needed care.  

Behavior such as Cassell’s is unconscionable.  He should save his political activism for the ballot box and teabagger meetings.  Punishing patients for their vote seems so—-Soviet.

Comments

  1. #1 Dr. O
    April 12, 2010

    I’ve found all kinds of irony in how the extreme right has handled the democratic victories this past year, but this guy takes the cake.

    On a related note, I understand Dr. Cassell was a pretty crappy doc. Not that it excuses his actions at all – I’m agreed completely with your post – but he may have been doing a favor to patients that were turned away by his sign…

  2. #2 Dianne
    April 12, 2010

    I have nothing to add except that I am greatly disgusted by both physicians in question but particularly Dr. Cassell.

  3. #3 Nathan Myers
    April 12, 2010

    Dr. Cassell performs an exemplary service by revealing to his patients (and the medical board) his own mental incompetence. If only all incompetent physicians would similarly put their patients on alert… Those equipped to understand the message were steered to a (probably!) better physician. Unfortunately, mentally impaired patients probably continued seeing him. Mentally impaired patients deserve competent treatment, too, even if they are unable to seek it out competently themselves.

    Tens of thousands of patients die through officially-approved medical incompetence, year in and year out. Only competent physicians can eject the incompetent from within their ranks. Thus far they have collectively shown overwhelming reluctance to act responsibly in this way, or even to advocate practices known to prevent deadly medical mishaps. It is this reluctance that makes rage at outsiders who seem to usurp their role seem hypocritical.

  4. #4 PalMD
    April 12, 2010

    While I am reluctant to agree with Nathan (on principle), as a profession we do consistently fail to adequately police ourselves for incompetence.

  5. #5 ginger
    April 12, 2010

    But, gee, I think it’s awful nice of Dr. Cassell to warn people that the guy handling their junk is going to make medical decisions based even in small part on his opinion of their politics. I would like to know in advance if any of my potential physicians, dentists, nurses, and so on are bigots or lunatics. “Changes in health care begin now,” indeed.

  6. #6 Pascale
    April 12, 2010

    I can’t imagine this actually happening, and yet it is.

  7. #7 mxh
    April 12, 2010

    I would like to know in advance if any of my potential physicians, dentists, nurses, and so on are bigots or lunatics.

    I prefer they lose their medical license (unfortunately, as Nathan mentioned above, doctors are terrible at rooting out incompetence or bigotry in their profession).

  8. #8 Shay
    April 12, 2010

    Ginger@5 — exactly! Who needs a physician who so obviously fails at critical thinking?

  9. #9 Nathan Myers
    April 13, 2010

    Sorry, what principle?

  10. #10 DLC
    April 13, 2010

    Can’t medicare decline to accept a physician who refuses to treat people based on personal bias ?
    They certainly could if that sign had said “If you’re black, seek urological care elsewhere.”

  11. #11 Jim
    April 13, 2010

    So you are opposed to the the firings and retribution being given to the Prop 8 supporters in California? I personally see nothing wrong with a professional saying that he or she will not purchase work related items from a business whose owner supported Prop 8.

  12. #12 Hanspeter
    April 13, 2010

    @jim #11 : Yes.

    This has been another episode of simple answers to simple questions.

  13. #13 Jesse
    April 13, 2010

    Jim — false equivalence.

    A doctor is providing a needed service. I can choose to go to a doctor or not; but if I choose not to I risk my life i some cases. So effectively, you really don’t have much choice.

    I can choose (or not) to patronize certain businesses, but those businesses are (under current law) obligated to serve anyone who shows up as a good-faith customer.

    As to the “retribution” on prop 8 supporters, telling someone you would not buy from a merchant who has publicly stated that he thinks you or your friends are inferior and that they might possibly violate the principle of serving good-faith customers (and the law in the process) well, no, there is nothing wrong with that. There IS something wrong with saying you won’t serve people on the basis of their beliefs, or race, or anything else that isn’t germane to the transaction involved. There is a reason it is against the law.

    If you were talking about a massive number of prop 8 supporters being denied service at restaurants and such, that is one thing. But that isn’t what you are referring to, I don’t think.

    (Has there been some mass persecution of bigots in California? People losing money because they decided to vote for prop 8? I haven’t got a whole lot of sympathy there, but even if I did, please explain to what you refer).

  14. #14 CB
    April 13, 2010

    Its not that doctors are bad at routing out incompetance, its just not in the self interest. Perhaps someday we will find a way to reward the profession as a whole for being competent which would encourage doctors to rigorously evaluate themselves so as to reap those rewards. Right now, it can only kill your career.

    I for one appreciate when people self identify as a doc I wouldn’t want to go to. Up to this point in my life, I’ve always had to find them the hard way.

  15. #15 PalMD
    April 13, 2010

    @Nathan
    the principle that I hate to agree with a commenter.

  16. #16 Jason
    April 13, 2010

    The far right has convinced themselves that the election was stolen by ACORN. Of course even if every voter ACORN is responsible for getting to vote was proven a fraud, Mr. Obama still would have won the election. Facts like these don’t get in the way.

    There is a systematic ignoring of reason in favor of dogma with this particular group. Its no coincidence that these people (in general) are the same people that ignore the evidence for evolution and global warming, based on political dogma.

    Of course this phenomenon isn’t restricted to the far right. The anti-vax movement is very much associated with some famous liberals. One can also argue that some liberals ignore all the historical writings supporting the Second Amendment as an individual right the same way some conservatives ignore all the historical writings supporting the strong wall before church and state supported by the founders.

    What is lacking in all of these cases is critical thinking and accepting facts that might not agree with one’s hypothesis.

  17. #17 Zuska
    April 13, 2010

    Dr. Cassell performs an exemplary service by revealing to his patients (and the medical board) his own mental incompetence.

    Yes and no. In some parts of the country – like rural areas – people don’t have loads of choices about which doctors they’d like to take their “business” to. If a doctor posts a sign like Dr. Cassell did, turning away patients of whatever political persuasion, those patients may not have many, or any, other options. For example, if my mother’s cardiologist suddenly outed himself as an Obama hater (I have no reason to believe he is, or would do so if he is), and made her feel uncomfortable about continuing to seek care at his practice, her next choice would likely involve a drive of 1 to 1.5 hours to obtain the same level of care. He would do her no favors by letting her know what wackaloon political thoughts are roaming around his skull when he’s not concentrating on her medical needs.

  18. #18 Nathan Myers
    April 13, 2010

    Zuska: Do you really believe that wackaloon thoughts, if present, would really be so well compartmentalized as not to threaten (e.g.) your mother’s safety and well-being? The inclination to post such a sign is an excellent indicator that they would not be. Sure, an extra 3 hours’ drive is inconvenient, but death seems worse.

    I know of people who do compartmentalize successfully; one of the best engineers at a previous employer had regular ongoing conversations with her spirit guide. However, it’s not something I would like to count on.

  19. #19 Dianne
    April 13, 2010

    as a profession we do consistently fail to adequately police ourselves for incompetence.

    As far as I know, no group of people of any sort has ever succeeded in adequately policing itself. That’s why there have to be external controls. Such as, for example, licensing boards. And I wonder if Florida’s licensing board could censor or withdraw Dr. Cassell’s license for his blatant act of prejudice?

  20. #20 D. C. Sessions
    April 13, 2010

    As far as I know, no group of people of any sort has ever succeeded in adequately policing itself. That’s why there have to be external controls. Such as, for example, licensing boards.

    Diane, is your local medical licensing board composed of non-physicians? Around here, that’s not the case.

    Then again, around here the homeopaths have their own board.

  21. #21 Dianne
    April 13, 2010

    is your local medical licensing board composed of non-physicians? Around here, that’s not the case.

    To tell the truth, I haven’t even the slightest idea who the licensing board around here is, apart from an arm of the state of NY. Department of Education, I believe. I assumed that they would be the usual mix of bureaucrats, politicians, and token experts of various sorts.

  22. #22 Nathan Myers
    April 15, 2010

    Firing somebody for having an Obama sticker is probably not, in fact, illegal. Welcome to America.

    The good news is that you can fire somebody for having a racist bumper sticker, or even for not having an anti-racist bumper sticker, or not enough of them. Welcome to America.

  23. #23 Calli Arcale
    April 15, 2010

    If you fire somebody for having an Obama bumper sticker, Nathan Myers, you will be liable for unemployment benefits. It *is* unlawful to fire somebody for that in America. The phrase is “wrongful termination”. It won’t get you jail time, but it’s still unlawful, and you will pay a financial price for it if the person you fired files a claim.

    Of course, you still can fire somebody who has an Obama bumper sticker. You just have to find a better reason than that, and make sure it’s sufficiently documented that the courts don’t find you guilty of wrongful termination.

  24. #24 Nathan Myers
    April 15, 2010

    In other words, if you’re willing to pay the unemployment premiums, then it’s the same as laying them off, which is also legal: it’s “termination without cause”. Of course, requirements on unemployment premiums vary by state. Welcome to America.

  25. #25 Laughing Redneck
    April 29, 2010

    Come on pal MD. Why does anyone need to go to this doctor when we have millions of doctors just waiting to use Obamacare? If his patients don’t like real doctors, then they should seek of the millions of doctors who has endorsed Obamacare. After all, medical care for Obamites is free.

    This is pretty hilarious. Now if we could just start doing this everywhere. If all conservative doctos would refer their patients to an Obamacare specialist …

    Frankly speaking, if Obamites like Obamacare so much, they should not seek medical attention from those whom they have harmed. It’s like shooting your neighbor in the ass, and then asking for his help.

    I recommend all conservatives in all businesses everywhere start boycotting and kicking out liberals until they surrender and return this country to the way they found it.

    I sure as hell will not be selling my products or offering my services to any of them. They can seek government assistance if they like government that much. When they need tech support from me, I’ll tell them to call the democratic national Convention. When they kill the HELLthcare bill and trash it, then we’ll talk. Until, then forget it. I’d rather go out of business than to deal with a traitor.

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