If you’ve had an abortion, you might want to look up your doctor’s voter registration.
A new study from Yale researchers published in the Proceedings of the National Academy of the Sciences found that Democratic and Republican primary-care physicians had significantly different responses to hypothetical patient scenarios involving controversial issues like marijuana or firearms. But the most divisive topic for doctors was abortion.
Republican physicians presented with a vignette about a woman who had two abortions in five years with no complications were “more likely to discuss the mental health aspects of abortion and to encourage the patient not to have more abortions.” On average, the Republican doctors also found this hypothetical patient’s situation to be “more concerning” than their Democratic colleagues did.
“For patients, our study suggests that they may need to be aware of their physician’s political worldview, especially if they need medical counsel on politically sensitive issues,” the study concludes.
The 200 plus doctors who responded to the survey were asked to rate how likely they would be to take a certain action in response to the patient vignettes on a scale from one to 10. The researchers specifically chose not to ask the physicians about party affiliation so as not to “alert survey respondents to the political nature of our study.” Instead, they used voter registration records to determine whether the respondents were Democrats or Republicans after the fact.
Dr. Matthew Goldenberg, a Yale psychiatrist and co-author on the study, told The Daily Beast that if you consider physician responses in the one to 10 range as being “unlikely to take [an] action” and responses six to 10 range as being “likely to take the action,” then Republican physicians were “twice as likely as the Democratic physicians to discourage the patient from having more abortions in the future.” Republican doctors were also 35 percent more likely to discuss “mental health aspects of abortion.”
What does “mental health aspects of abortion” mean? The ambiguity of that phrase was part of the study.
“It was phrased as exactly that,” Dr. Goldenberg explained, “and physicians interpreted that approach as they might.”
There is, of course, scientific evidence to consult on this question. In 2008, the American Psychological Association Task Force on Mental Health and Abortion conducted a literature review and determined that “there is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women.”
The data on multiple abortions, however, was “more uncertain,” which is exactly why Goldenberg and his co-author, Yale political scientist Dr. Eitan Hersh used a vignette involving a patient who had received two elective abortions.
“All of the vignettes were meant to represent reasonable clinical scenarios that a primary-care physician might face and [they] were constructed to be ambiguous enough about what the severity and/or clinical decision-making around any interventions might be,” Goldenberg told The Daily Beast.
The APA Task Force did determine that some studies found positive associations between multiple abortions and more negative mental health outcomes but it was also careful to qualify that these “may be linked to co-occurring risks that predispose a woman to both multiple unwanted pregnancies and mental health problems” (PDF).
In the absence of more conclusive evidence on that question, then, it’s telling that Republican doctors were significantly more likely to say they would bring up the “mental health aspects of abortion” with the hypothetical female patient.
“It may be more likely that people who are anti-abortion are going to think that abortion is associated with bad mental health outcomes when the science doesn’t support that,” said Dr. Goldenberg.
But Goldenberg is quick to note that primary-care physicians who personally support abortion rights may bring their politics into the exam room in a different way.
“While conducting this [study], we also heard anecdotes of patients who expressed concern, for example, that their physicians urged genetic testing even when the genetic testing was not necessarily going to change the patient’s decision about whether to terminate a pregnancy or not,” he said.
Overall, Goldenberg and Hersh recommend in the study that all physicians “consider how their own political views may impact their professional judgments,” especially given their other findings about Republicans’ and Democrats’ differing responses to patient vignettes involving marijuana, sex work, and gun ownership.
But given that a certain amount of political influence is probably unavoidable, Goldenberg recommends that patients keep in mind that the doctor’s office is not some sort of value-neutral space.
“Patients should be aware that—based on the results of the study—physicians bring some of their own political views, whether consciously or unconsciously, into the exam room with them and may make treatment decisions based on those views,” he told The Daily Beast. “So if a patient is seeking care for a health issue that has some political salience—abortion being one of them—they may want to know whether their physician has certain political views that will impact the recommendation one way or another.”