I’ve been a physician for several decades, seeing patients and functioning as a medical teacher; clinical, translational, and bench researcher; and administrator. Adapting to medical practice in three nations and several U.S. states has been quite challenging at different times, but I really think the current medical environment has been the most vexing of all! That even trumps the periods I spent, while at the University of Southern California Norris Comprehensive Cancer Center, taking tours of duty as an internal medicine attending physician at the jail ward of LA County Medical Center!
There was a time when the average patient (and the broader community) appropriately considered nurses to be the most ethical and admired folks in the community, with physicians being a close second in these polls. Surveys suggested that these two groups were viewed as honest, altruistic, and trustworthy while providing great benefit to the community. We all know those professions that were at the bottom of the list, and unfortunately, ours has become closer to them.
Derek Raghavan, MD, PhD, FACP, FASCO, FRACP, FAAAS
The Winds of Change
Perhaps during the COVID-19 pandemic, things began to change, and frankly our profession was partly responsible. We had prominent medical and scientific representation in medico-political organizations such as the Centers for Disease Control and Prevention that simply seemed unable to define and justify consistently sensible policy recommendations for dealing with that unprecedented crisis. Physicians who had become professional politicians added to the confusion, frequently opining outside their (former) field of expertise. This new situation did not seem like rocket science to me. For example, at the Levine Cancer Institute, we issued rational and evidence-based guidelines for managing patients with cancer early in the crisis,1 and our approach kept our patients safe.
Nonetheless, the community at large began to lose confidence in medical knowledge and the scientific basis for COVID-19 recommendations at that time. This was compounded by a broad range of physicians and scientists with no direct expertise in infectious disease management opining widely in favor of spurious and evidence-lacking strategies of control and treatment. I imagine that many of us recall sadly the television coverage of a team of ICU nurses, who were daily taking great personal risk (prior to vaccination availability), standing arms folded and with masks in situ, being abused by a ragged crowd of protesters outside their hospital on the issue of masking rules vs individual “rights.” It was no accident those states that took an evidence-based approach had much lower COVID-19 death rates than those who followed rhetoric and nonsense from their political leaders.2
Medicine and science have now become part of the current political battle between those who harbor extremist political opinions (of all persuasions). This has led to major cuts in funding of medical research, appointments of leaders within the health-care domain who are known to have extremist views (often without any supporting evidence for their opinions), random and uncritical staff reductions, and closures of many scientific programs with likely substantial scientific and financial loss by our community.3 This situation is illustrated by the chaos surrounding the misrepresentation of measles vaccination and the tragedy of the consequently emerging minor epidemic of a previously obliterated disease (with some resulting deaths).
Challenges in the Clinic
Against this background, those of us who still go to clinic and see patients are faced with some new challenges:
- Generic disbelief of science and scientific evidence;
- Misreporting and politicizing of medical practice and recommendations (eg, vaccine denial, use of some standardized treatment regimens for a range of diseases);
- An increasing mistrust regarding conflicts of interest in prescribing patterns (perhaps with fair justification in some instances);
- Increasing challenges for the provision of the basics of care to underprivileged populations. (I cannot conceive of a more foolish approach to cost-containment for national health expenditure.)
In my clinics and in my consulting work outside the hospital, I increasingly find patients expressing concern and confusion about issues that may relate directly to their own medical care or that of their families. They ask about the impact of reductions in funding and staffing for hospitals and clinics, rising costs of pharmaceuticals, potential changes to Medicare and Medicaid, increasing costs of ancillary services and medical supplies, increasing stringency of denials, and oversight within the health insurance industry, among other topics. All of this occurs against a background of increasing mistrust of the medical profession in general, although curiously I do find that my own patients still seem to trust me as their individual clinician (a phenomenon widely noted in recent years by other physicians).
Transparency and Honesty
I don’t think the clinic is the place to proselytize politically. However, when dealing with patients, transparency and honesty are important. When challenged by medico-political questions, I try to focus on the basis of the concern: Is the issue one of access, finance, delay in care, availability of treatment/medications, or ancillary issues (such as transportation, food insecurity, health insurance denials, or whatever)? When these items have clear solutions that are apolitical, I simply address them pragmatically: for example, “this is the problem…, and here is the solution.”
More challenging are the issues where there is a political overlay. How does one address a question like “Why can’t you guys get things straight—What IS the straight scoop on vaccination?” In that setting, I focus on the extensive, incontrovertible data that are available and state my position, sometimes with a recommendation for resolution of the problem. For example, commonly the issue of concern is financial or regarding access, and I can simply direct the patient to a clinician’s social work department or a financial toxicity tumor board.4
When patients or social contacts complain about delays or deficiencies in the broader health-care system, I simply remind them that health-care resources are being curtailed according to a predefined plan that was advertised in recent political campaigns and de facto supported by the electorate.5 I note there were excesses in health-care expenditures through many past federal and state political administrations, and many of them needed to be addressed in a structured fashion (in preference to a cookie-cutter approach), and the way to express dissatisfaction is via the ballot box.
What is sad is the confusion that seems to be increasing in the wider community about a range of health-care issues and practices. At our core, physicians and nurses are still doing noble work and trying to improve the health of the population at large…. Politicians not so much! Why don’t people understand that?
A potential solution is for the various professional organizations to muster their courage and take a position on these issues.5,6 This can be done dispassionately and using data, even if they have a concern about protecting their not-for-profit status. In the late 1930s, faced by an emerging menace that threatened constitutional law, physicians largely kept silent. That was a huge error!
DISCLOSURE: Dr. Raghavan reported no conflicts of interest.
REFERENCES
- Raghavan D, Kim ES, Chai SJ, et al: Levine Cancer Institute approach to pandemic care of patients with cancer. JCO Oncol Pract 16:299-304, 2020.
- Raghavan D: Arrogance or stupidity? Unsuccessful approaches to COVID-19 in Western society. JCO Oncol Pract 17:125-127, 2021.
- Reardon S: Killed NIH grants could waste billions of dollars. Science 388:12-13, 2025.
- Raghavan D, Keith NA, Warden HR, et al: Levine Cancer Institute Financial Toxicity Tumor Board: A potential solution to an emerging problem. JCO Oncol Pract 17:e1433-e1439, 2021.
- Raghavan D: Animal Farm, 1984 and the Hunger Games. HemOnc Today, October 25, 2016. Available at https://www.healio.com/news/hematology-oncology/20161011/animal-farm-1984-and-the-hunger-games. Accessed June 17, 2025.
- Chen AT, Murthy VH: The power of physicians in dangerous times. N Engl J Med 392:1873-1875, 2025.
Dr. Raghavan is an oncologist at the Veterans Administration Health Care Center, Charlotte; Emeritus Professor at Wake Forest School of Medicine; and Senior Strategic Advisor at Henry Ford Health and Michigan State University Cancer Collaboration.
