We Cannot Provide Care With Our Hands Tied Behind Our Backs

While pledging to “make America healthy again,” President-elect Donald Trump gave former environmental lawyer Robert F. Kennedy Jr. — whose curriculum vitae includes neither scientific background nor a medical degree — carte blanche to “go wild” on health under his administration. These two announcements seem incompatible with each other. Aside from having no medical expertise, Kennedy has infamously pushed conspiracy theories as fact, and physicians worry that platforming him will further undermine public trust in medicine.

This is merely one example of the impending embrace of pseudoscience over reason at a policy level — and it’s deeply concerning. It signals to the physician community that our medical expertise and clinical judgment, carefully cultivated over years of intensive training and experience, don’t matter.

This context of politicization and entitlement superseding critical thinking confounds our ability to deliver good care. Politicians and the general public increasingly demand what they want from doctors, and it appears that we are, and will be, expected to comply.

Normalizing Violence

A few weeks ago, a patient became angry with me for not discharging her immediately (she was not appropriate for discharge, and we were in the middle of rounds). She followed my team down the hall and physically assaulted me, yelling, “Bitch, give me my discharge papers now!” Fortunately, a nearby nurse pulled her off me. I spent the next several days on edge, highly irritable, and prepared to sprint at a moment’s notice.

Violence against healthcare workers is a serious and growing problem. In 2018, healthcare workers comprised 73% of all nonfatal workplace injuries or illnesses due to violence. According to a 2024 poll by the American College of Emergency Physicians, 91% of emergency physicians reported that either they or a colleague were the victim of violence in the last year.

The issue is multifactorial. In the hospital, we often see people at their worst, when their decision-making and impulse control may be suboptimal. But I wonder whether something else might be at play: the normalization of violence in our current political climate. This is not to say that any politician, including Trump, is unilaterally responsible for violence against doctors. But our politicians indisputably have a problem with volatile rhetoric promoting violence.

Trump has declined to condemn the violence of white nationalism, and has shown he will verbally attack anyone he does not agree with, even for a perceived slight, as he has demonstrated with vitriolic personal attacks on his political competition. He’s suggested that his opponents deserve violence, from threatening journalists who refuse to reveal confidential sources to suggesting protestors should be shot.

Elevating inflammatory, provocative rhetoric that promotes violence to the national stage sends the message: If you want something, assault is a reasonable approach.

Is it any wonder that more patients feel entitled to use violence against doctors when dissatisfied?

Legal Threats Restrict Doctors and Hurt Patients

The threat of physical violence is not the only barrier to providing appropriate care looming over physicians’ heads.

Since the Dobbs decision overturned Roe v. Wade, politicians have interfered in safe medical decision-making with draconian abortion restrictions. Two Texas women, Josseli Barnica and Nevaeh Crain, recently died after delayed emergency care for miscarriages, as Texas law threatens prison time for interventions that end a fetal heartbeat.

Every physician should read ProPublica‘s report of Crain’s death:

“They suspected that she had developed a dangerous complication of sepsis known as disseminated intravascular coagulation; she was bleeding internally.

Frantic and crying, [her mother] locked eyes with [Crain]. “You’re strong, Nevaeh,” she said. ‘God made us strong.’

Crain sat up in the cot. Old, black blood gushed from her nostrils and mouth.”

Anti-abortion advocates may point out exceptions to the restrictions, arguing the doctors failed their patients.

But they forget that Attorney General Ken Paxton has actively threatened physicians with prosecution, even when abortion is determined to be an appropriate step in care for a high-risk patient. They forget that he willfully fought federal guidelines on providing appropriate treatment to stabilize emergently ill pregnant patients, misrepresenting the guidelines as an effort to “transform every emergency room in the country into a walk-in abortion clinic.” They forget that abortion bans in certain states, like Idaho, include no provision to protect the health of the mother.

Who suffers the consequences of these legal threats against doctors? Not the (often older, male, not medically educated) politicians legislating based on their personal beliefs. Dictating people’s medical decisions is easy if the outcome doesn’t directly affect you. It’s as though the football players in a ’90s high school movie have overrun the chemistry lab, thoughtlessly mixed any number of things together, and absconded from the explosion.

I see these deaths as a direct outcome of bullying doctors, and I fear it may not end with Dobbs. Discouraging vaccines, banning fluoride, and promoting unregulated supplements — the concerning list of plausible ideology-based healthcare policies during Trump’s second term is extensive.

Our Tolerance For Abuse Is Limited

We cannot apply our training or ethics if these threats overshadow our ability to practice. The threats, often driven by politics, scream entitlement: “I will force you to do what I want, and you will accept it.”

Actions have consequences. Physician burnout remains high, increasing both risk of medical errors and healthcare costs. A recent Doximity poll revealed that 63% of physicians would not want their children to pursue medicine. Meanwhile, many physicians may leave clinical care altogether. Hospitals increasingly rely on locum tenens for staffing shortages, which is not conducive to continuity of care. Ob/gyn residency applications dropped 4.2% in states with abortion restrictions, compared to 0.6% in states with abortion access. Obstetricians have left Texas, Idaho, Tennessee, and Oklahoma, creating reproductive healthcare deserts.

As a community, we’ve had many discussions about the line between our professional obligations and our autonomy. Some colleagues have invoked the “medicine is a calling” argument, discouraging physicians from leaving restrictive states for patients’ sake, or arguing that we have a responsibility to stay in the field, no matter the cost.

But I and many other doctors disagree. This new culture of dictating healthcare by force jeopardizes our livelihoods and imperils our safety. While we are obligated to save lives, we are not obligated to sacrifice our careers, health, or lives in a climate where we are disrespected and bullied into submission. That is decidedly not the job we understood when we became doctors.

Ultimately, these consequences do not hurt us as much as they hurt our patients. I sincerely hope the next administration will consider this with humility, but their past behavior makes me less than optimistic.

Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York.