Politics in the Clinic

On June 24th, The New York Times ran a piece which highlights growing tensions among medical staff at the University of California, San Francisco Medical Center (UCSF) over the issue of the Israel-Gaza war. I found the piece and its implications disturbing, for reasons which will become clear. The author begins by describing a protest outside of the UCSF hospital in which—

The protesters were medical students and doctors. And the chants of “intifada, intifada, long live intifada!” could be heard by patients in their hospital rooms at the U.C.S.F. Medical Center.

This is very embarrassing. I don’t envy the PR guy who had to explain why such a demonstration by staff and students was even allowed to occur in the first place (the fact that it was within earshot of patients is especially egregious; what were the protesting doctors thinking?). Unfortunately, academic medicine is not immune from some of the worst cultural pathologies of American university life—pathologies such as institutions making declarations about things they have no business commenting on, or its members becoming so obsessed with the cause du jour that they absolutely must tell everyone about it and are compelled to disrupt everything, everywhere they go, on account of it.

In what follows I would like to suggest, ever so gently, that the medical profession reconsider the wisdom of embracing activism in the workplace.

The author continues—

The Israel-Hamas war has frayed social ties around the world, undermining family gatherings and school classrooms. But rarely has it fractured a medical community the way it has at U.C.S.F., where a staff known for celebrating diversity has fallen into an atmosphere of backbiting and distrust.

Aside from being unfortunate and embarrassing, the whole affair is, if you think about it for more than a few seconds, entirely predictable. Take one of the most contentious conflicts in modern history, one so contentious that many people organize their lives and worldviews around it and are willing to kill other people for it, then make it the legitimate subject of debate, protest, and advocacy within an organization dedicated to something else entirely, and lo and behold, tensions rise, trust falls, and everyone gets just a little more irritable and paranoid. Who woulda thunk it?!

Over the past several months, doctors, medical students and patients have filed hundreds of complaints with the university administration. Some have alleged instances of antisemitism on campus. Others have said they were inappropriately silenced when they tried to express pro-Palestinian points of view.

One faculty member featured in the piece is Dr. Jess Ghannam, a psychologist who has been at UCSF for 30 years and has “worn a watermelon pin, a symbol of solidarity with Palestinians.”

Patients have thanked him for wearing the pin, he said, because it acknowledged their horror at the destruction in Gaza. But he said that while he has freely worn the pin, some of his colleagues have been instructed by their supervisors to remove their pins and kaffiyeh.

U.C.S.F. has a dress code prohibiting political symbols in patient care settings, but Dr. Ghannam said staff members for years have worn pins supporting abortion rights, Black Lives Matter and the L.G.B.T.Q. community without repercussions.

I’m not writing this piece to criticize the “Palestinian cause” or any other particular cause. In fact, I sympathize with Dr. Ghannam and his confusion, despite the fact that we (presumably) hold diametrically opposed views on the issue in question. If I were in his position, I would naturally think that an institution which promotes causes typically associated with the political left would at least be tolerant of showing support for Gaza. I can also imagine being baffled by what seem like arbitrary or inconsistently applied rules for what we can or can’t say on this or that issue. Furthermore, it is hard to know what consequences, if any, one risks incurring in the event such rules are transgressed. Will your supervisor gently tell you to tone it down and get on with your work? Maybe, or maybe your professional rivals will take this golden opportunity to make an example out of you, and before you know it you find yourself the target of a social media mob that’s been riled up by exaggerated, contextless, or malicious accusations.

The article cites UCSF physicians with pro-Israel as well as pro-Gaza views, and one thing both parties apparently agree on is that their position is under attack, that they are being subject to intimidation, and meant to feel “unsafe”. One doesn’t need to be a psychiatrist to sense that this isn’t a psychologically healthy work environment. All this might even make one question whether a medical center is well suited to play referee with political speech in the first place...

In December, a task force of hospital doctors focused on antiracism discussed via email whether to issue a statement calling for a cease-fire.

And this, right here, is the problem. Hospitals that are ostensibly dedicated to a fairly narrow mission—typically some combination of biomedical research, patient care, and medical education—have broadened their scope of concern to encompass virtually any cause deemed politically fashionable. Such causes are often tied to the actual practice of medicine in the most tenuous of ways, or are somehow linked to the field of public health (public health is the one of those universal justifications for anything. Consider that virtually any political/social problem can be reframed and rephrased, even if awkwardly, as a public health problem. In that spirit, I’m tempted to say that the proliferation of causes ludicrously dressed up as “public health problems” is itself a major public health problem.).

The fact that these causes are almost uniformly left-wing isn’t my concern here. A hypothetical hospital in which doctors wore pins and protested for conservative causes would likewise be problematic for precisely the same reasons. Some patients might be quite comforted seeing their physician bejeweled with pins proudly showing his support for gun rights, strong border enforcement, “traditional family values”, or whatever. But some patients would obviously not be comforted by such a display, and rightly so. You physician has no more business advertising his conservative opinions on guns, the border, or family values than he does his progressive opinions on race, sexuality, or anti-colonialism. Remember when you were a child and would misbehave in a formal situation, and your mom would say something like “this isn’t the time or place for that behavior”? It’s kind of like that. And to be blunt, your behavior is a bit childish, and is an embarrassment for the rest of us who show up to work having left our politics at the door. As much as you may care about your pet issue, the fact is that when you’re at work, it just isn’t relevant.

But we physicians have a duty to speak out against injustice and…

Bullshit. No, you don’t, and you look foolishly grandiose pretending you do. Believe it or not, as physicians neither you nor I nor anyone else has a duty to speak out about any subject of public policy if we don’t want to. And if you want to speak out, you can do so outside of work, just like the rest of us. It’s really quite simple: work is for work, not activism. We were hired because of our competence as physicians, not as social reformers, repairers of historical injustice, mediators of international conflict, or society’s “change agents”.

What is the solution to all of this? My personal opinion is that hospitals have absolutely no business whatsoever commenting publicly on any politically contentious issue of any kind. This applies to all hospital, but especially academic medical centers, many of which, like UCSF, have influential reputations backing up their statements (reputations which, we should remember, are not destined to shine forever). Similarly, individual hospital staff and students should not bring their politics to work with them. Full stop. A big part of activism essentially consists in annoying a lot of other people, so at the very least it should be kept out of work as a matter of simple courtesy.

Let’s take a giant step back and try to take the “average guy on the street” perspective: “why,” he might ask, “are UCSF doctors drafting statements on wars happening on the other side of the planet in the first place? Or on race relations? Or whatever else they can’t help but have an opinion on? Who are these statements for and why does anyone care? Aren’t these my doctors? I just want treatment for my bone cancer.”

If only these doctors and medical students had better things to do with their time.

A U.C.S.F. spokeswoman, Kristen Bole, said the university and medical center are working hard to ensure a healing environment for its patients and respect the free speech rights of its employees.

I’m pretty close to a free speech absolutist, yet I’m also a little puzzled by the part about “free speech rights of its employees”. Yes, I know, UCSF is a public institution, and there’s the First Amendment etc. But we know that “free speech” in a work context does not mean “say whatever you want”. What is the purpose of having “free speech” in the workplace? At a minimum, it must mean that you can speak freely about issues relevant to your job, like voicing a controversial opinion about a disease or its treatment, without fear of retaliation (we are not doing well in this area either, unfortunately). But how is the organization’s mission helped by tolerating—or at times even encouraging—speech on issues that are both tangential to the task for which you have been hired, and virtually guaranteed to stir the pot with colleagues, patients, and the broader public?

I have my views on Israel-Gaza, just as I do with all kinds of thorny topics. I’ve written about a couple of them. I’ve discussed some with colleagues when we are both interested in talking about it and are confident it won’t disrupt our working relationship. Importantly, such conversations are private, and tend not to take the form of public protest, and certainly don’t involve pins, flags, or bullhorns. How often am I compelled to “raise awareness” about my political causes at work in that fashion? I’m not. Why? Because I’m a grown up. Not bringing politics into the hospital is on the same basic level as not wearing perfume or cologne in the hospital, something every medical student is taught very early. I understand that my politics aren’t relevant to my patients’ care, and that my patients don’t care about my politics. I understand that my support for this or that cause doesn’t make me a better doctor. I understand that protesting for these kinds of things outside my own hospital—within earshot of my patients!—is a silly performance that ultimately debases me and my profession.

We get endless messaging about work-life balance, so let’s consider this an exercise in that spirit. If you support Israel: great, that’s in the “life” column, work doesn’t care. If you support Gaza, great, that’s in the “life” column, work doesn’t care. And so on for every other issue. Perhaps—just perhaps—we would be wise to leave all that at home, so we can continue devoting our attention at work to what really matters.

The good news is that if I can do it, and most of my colleagues can do it, then surely the illustrious staff of UCSF can do it too.