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05.26.10

Why Doctors Make Crazy Politicians

Rand Paul is just the latest in a line of physician-pols who are embarrassing the profession. Dr. Kent Sepkowitz on why medicine and politics don’t mix.

What do the Senator Tom Coburn and almost-Senator Rand Paul have in common? I mean, in addition to being cranky white guys who won’t shut up. They’re both doctors. The medical profession, once known for attracting the intellectually curious, the save-the-world dreamers, or at least those who could kill a standardized test, has now become a magnet for a special type of political uber-nut: the doctor senator, a confusing amalgam of an infantile selfishness, Marlboro man frontier integrity, and the crude insensitivity that masquerades as straight talk.

Paul and Coburn would become the most extreme duo in the recent history of the U.S. Senate, a place that already has its share of flat-earthers and Jefferson Davis revisionists.

As a doctor, this is painful to watch. And for me, it’s even worse. Tom C. (class of 1983) and I (class of 1980) share something important: We are both graduates of the University of Oklahoma College of Medicine (though only I am a true Okie: Dr. Tom, born in Wyoming, is just trying to pass). Coburn was three years behind me at OU and I never once saw him or heard of him till he began running for Congress by driving his truck along rural roads around Muskogee. But in our post-Richard Blumenthal world, let the record state clearly that my dear friend Tom and I attended medical school together.

In the history of the Senate, 51 doctors have served (including President William Henry Harrison, who never practiced medicine or, for that matter, the presidency, as he caught pneumonia and died soon after his inauguration). Most served in the 19th century. In fact, since World War II, besides Coburn and John Barrasso of Wyoming, only two other physicians have sat in the upper chamber: William Frist, the (lousy) Senate Majority Leader in the Bush Junior days, and Ernest Gruening, a New Yorker educated at Harvard who became a journalist rather than a practicing doctor. Just a few other doctors have played well in the larger political sphere; Howard Dean comes to mind.

Tom and Rand will change all of that—and not just by swelling the numbers. They also would become the most extreme duo in the recent history of the U.S. Senate, a place that already has its share of flat-earthers and Jefferson Davis revisionists. Next to them, their physician-mate, Barrasso, a conservative orthopedist currently representing Wyoming, seems of standard Republican cloth-coat issue—small government, lower taxes, sanctity of life, blah blah. Reagan redux with a yawn.

Why oh why is my profession so oddly represented in Washington? We are probably not that much worse than any other group in our socioeconomically matched demographic, are we? There are among us lefties and righties, whack-jobs and dullards just like the citizens across this great and glorious land of ours. So what gives?

I have a few theories. First, doctors get to hear themselves talk. A lot. Yes, I know we are supposed to be good listeners, but please—patients want to hear what we have to say. Unlike, say, your lawyer or your accountant, where you kind of nod out and hope nothing important is being said, with a doctor you tend to hang on the words—at least if you’re seeing us with a specific problem. As such, we are given a bully pulpit every day to make pronouncements and recommendations. People write down what we say; they call and tell their friends about the visit, “well, I saw the doctor and he said…”

Such a zealous fan base can go to a guy’s head. We start to think that, unlike most everyone else, we actually have something to say. And what’s the difference between treating a malady of the digestive system and treating a malady of the U.S. tax code? Besides everything, that is.

Doctors also possess a native sobriety—if not dullness—that seems flat-out senatorial at times. We are a profession of solid but never snappy dressers who wear nice but not too nice shoes. The abstemious face, the dry mechanical handshake, the steady gaze, the uninflected tone: These are the markings of a good doctor—or of Senator Bigwig.

But I suspect the most compelling reason is this: Doctors more than just about anyone else deal endlessly with the regulatory aspect of government. For us, every day is April 15. We are awash with forms: Entire cottage industries have appeared to deal with both the forms and the regulation to assure compliance with the forms. It is the coin of our realm and has been since Medicare and Medicaid were hatched. Most of us can stand it most days; it is a major pain, an annoyance, a waste of time etc.—but not more.

For a few people, however, Tom and Rand among them, it appears to represent a systematic threat to manhood, one that, my fellow Americans, cannot, should not, and must not be tolerated. Articulating their aversion to filling out forms has become the proof and justification of their world view, the perfect example of the clumsiness and inevitable inefficiency of health care (and all government). And in response we hear the sustained adolescent shriek YOU CAN’T MAKE ME CLEAN MY ROOM that is the heart and soul of the libertarian movement—the thing that gives it its visceral appeal as well as its high-voltage, seemingly infinite energy.

The problem is that the hard-core libertarians too often go off the deep end: Theodore Kaczynski and Timothy McVeigh, anyone? That’s where Rand and Tom come in. They’re doctors—they can’t be that crazy, right? With the doctor duo, you get both the primal tantrum but also the smug confidence of privilege: Both men are the well-educated scions of successful dads. Tom and Rand are not hardscrabble hard-luckers, though that is the brand they are selling—and being from Muskogee, Oklahoma, and Bowling Green, Kentucky, certainly helps. As they advance their radical politics, they bring not just the suave calmness of a doctor at the bedside but also its implicit social standing: For despite appearances, they are not countrifying the libertarian movement, but rather country club-ifying it. Now that’s a trick their senatorial colleagues can truly understand.

Kent Sepkowitz is an infectious disease specialist in New York City. He has contributed to The New York Times, Slate, and, oh-so-briefly, O Magazine. He also writes academic medical articles that are at times pretty tough sledding.