Politics in the doctor’s office

Dr. Jack Cassell, a urologist in private practice in Florida, is very, very disgruntled with the passage last month of the federal health reform bill. So disgruntled, in fact, that he has posted a notice on his door, telling patients who voted for President Obama to find another doctor.

The story has provoked a firestorm of public opinion ever since appearing late last week in the Orlando Sentinel:

A doctor who considers the national health-care overhaul to be bad medicine for the country posted a sign on his office door telling patients who voted for President Barack Obama to seek care "elsewhere."

"I’m not turning anybody away – that would be unethical," Dr. Jack Cassell, 56, a Mount Dora urologist and a registered Republican opposed to the health plan, told the Orlando Sentinel on Thursday. "But if they read the sign and turn the other way, so be it."

The sign reads: "If you voted for Obama… seek healthcare elsewhere. Changes to your healthcare begin right now, not in four years."

Dr. Cassell’s politics apparently aren’t limited to a sign on the door:

In his waiting room, Cassell also has provided his patients with photocopies of a health-care timeline produced by Republican leaders that outlines "major provisions" in the health-care package. The doctor put a sign above the stack of copies that reads: "This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it."

The story hit the New York Times this weekend, where at last count more than 300 readers had weighed in with comments. Some were sympathetic. "Three cheers for this doctor!" someone wrote. But many were dismayed and highly critical. "His patients should be thanking God that Dr. Cassell has given them advance warning of his character," one person wrote. "If I were his patient, I’d be running away like the wind. Turning people away based on their beliefs is one mm away from giving them bad care for the same reason."

As of this morning, the original story in the Orlando Sentinel had more than 3,300 comments.

So is Dr. Cassell a villain (or at least a jerk)? Or is he a hero for standing up for what he believes?

Nowhere is it written that physicians can’t express their personal opinions or that they can’t be politically involved. Nor are they necessarily compelled to treat every patient who walks in the door. Physicians in private practice can and do dismiss their patients, although usually this is for clear reasons, such as abusive behavior, noncompliance, prescription-forging, refusal to cooperate in paying a bill, and so forth.

Dr. Cassell appears to be walking a very fine line of professionalism, however. It’s one thing to have political opinions; it’s quite another to impose them on unsuspecting patients. I’m not sure how to interpret Dr. Cassell’s actions as anything other than hostility toward those who don’t share his views. It’s hard to imagine patients who disagree with him politically wouldn’t feel coerced or unwelcome in his practice (the sensitive specialty of urology, no less), and that this wouldn’t somehow spill over into their interactions with the doctor, possibly to the detriment of their care.

From the Orlando Sentinel:

Cassell may be walking a thin line between his right to free speech and his professional obligation, said William Allen, professor of bioethics, law and medical professionalism at the University of Florida’s College of Medicine.

Allen said doctors cannot refuse patients on the basis of race, gender, religion, sexual orientation or disability, but political preference is not one of the legally protected categories specified in civil rights law. By insisting he does not quiz his patients about their politics and has not turned away patients based on their vote, the doctor is "trying to hold onto the nub of his ethical obligation," Allen said.

"But this is pushing the limit," he said.

It’s not clear if the Florida Board of Medical Practice is going to take a look at the case. There doesn’t appear to be any medical licensing statute that specifically addresses activity such as Dr. Cassell’s. Is he being unprofessional? Probably. Immature? Absolutely. But has he done something illegal or discriminatory? Probably not, at least according to the letter of the law. Whether he’s violating the spirit of the medical ethos is another issue altogether, and one I’m not sure he and his supporters are capable of grasping.

If action can’t be taken against his medical license, here’s another idea: Make this guy go back to junior high for a week. Maybe he’ll learn something about how not to be such a sore loser.

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