While pledging to “make America healthy again,” President-elect Donald Trump gave former environmental lawyer Robert F. Kennedy Jr. — whose resume does not include scientific training or medical diploma – carte blanche for “go wild” on health under his administration. These two announcements seem incompatible with each other. In addition to having no medical expertise, Kennedy has the infamous pushed conspiracy theories as a fact, and doctors fear that its platform will further weaken public confidence in medicine.

This is just one example of the imminent embrace of pseudoscience over reason at the policy level – and it is deeply concerning. This signals to the physician community that our medical expertise and clinical judgment, carefully cultivated over years of intensive training and experience, does not matter.

This context of politicization and law which replaces critical thinking confuses our ability to provide quality care. Politicians and the general public are increasingly demanding what they expect from doctors, and it seems we are and will be expected to obey them.

Normalize violence

A few weeks ago, a patient got angry with me because I didn’t discharge her immediately (she wasn’t fit to be discharged and we were in the middle of a round). She followed my team into the hallway and physically attacked me, yelling, “Bitch, give me my release papers. NOW“Luckily, a nearby nurse removed her from me. I spent the next few days on edge, very irritable and preparing to sprint at any moment.

Violence against health care workers is a serious problem and growing problem. In 2018, healthcare workers made up 73% of all non-fatal occupational injuries or illnesses due to violence. According to a 2024 survey by the American College of Emergency Physicians, 91% of emergency doctors reported that they or a colleague had been a victim of violence in the past year.

The problem 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 if 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 undoubtedly have a problem with volatile rhetoric encouraging violence.

Trump has refused to condemn the violence of white nationalism, and has shown that he will verbally attack anyone he disagrees with, even over a perceived offense, as he demonstrated with vitriolic personal attacks on his political competition. He suggested that his opponents deserve violence, since threatening journalists who refuse to reveal confidential sources suggesting to protesters should be slaughtered.

Bringing inflammatory and provocative rhetoric that promotes violence to the national stage sends the following message: If you want something, aggression is a reasonable approach.

Is it any wonder that more patients feel justified in resorting to violence against doctors when they are dissatisfied?

Legal threats restrict doctors and hurt patients

The threat of physical violence is not the only obstacle to providing appropriate care that hangs over the heads of doctors.

Since the Dobbs decision overturned Roe v. Wadepoliticians have interfered in safe medical decision-making by imposing draconian restrictions on abortion. Two women from Texas, Josseli Barnica And Nevaeh Crainrecently died after delaying emergency care following miscarriages, while Texas law threatens prison time for procedures that stop a fetal heartbeat.

Every doctor should read ProPublicathe report of Crain’s death:

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

Frantic and crying, (his mother) locked eyes with (Crain). “You are strong, Nevaeh,” she said. “God has made us strong. »

Crain sat up in bed. Old black blood gushed from his nostrils and mouth. »

Abortion supporters may point to exceptions to the restrictions, arguing that doctors have failed their patients.

But they forget that Attorney General Ken Paxton doctors actively threatened prosecutable, even when abortion is considered an appropriate step in the care of a high-risk patient. They forget that he voluntarily fought federal guidelines on providing appropriate treatment to stabilize emergency pregnant patients, misrepresenting the guidelines as an effort to “turn every emergency room in the country into a walk-in abortion clinic.” They forget that abortion bans in some states, like Idaho, have no provisions to protect the mother’s health.

Who suffers the consequences of these legal threats against doctors? Not politicians (often older, male, without medical training) who legislate based on their personal beliefs. It’s easy to dictate people’s medical decisions if the outcome doesn’t directly affect you. It’s like the football players from a ’90s high school movie invaded the chemistry lab, thoughtlessly mixed up a few things, and ran away from the explosion.

I view these deaths as a direct result of harassment from doctors, and I fear this will not end with Dobbs. Discourage vaccines, ban fluoride and promote unregulated supplements — the disturbing list of plausible ideologies health policies during Trump’s second term is considerable.

Our tolerance for abuse is limited

We cannot apply our training or ethics if these threats overshadow our ability to practice. The threats, often politically motivated, 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 the risk of medical errors and health care costs. A recent Doximity survey found that 63% of doctors would not want their children to pursue medical studies. Meanwhile, many doctors may abandon clinical care altogether. More and more hospitals rely on locum tenens due to lack of staff, which is not conducive to continuity of care. Obstetrics/Gynecology Residency Applications fell 4.2% in states with abortion restrictions, compared to 0.6% in states with access to abortion. The obstetricians have left Texas, Idaho, Tennessee and Oklahoma creating reproductive health care deserts.

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

But me and many other doctors disagree. This new culture of dictating health care by force jeopardizes our livelihoods and jeopardizes our security. Although we are obligated to save lives, we are not obligated to sacrifice our careers, our health, or our lives in a climate where we are disrespected and bullied into submission. This is definitely not the job we understood when we became doctors.

Ultimately, these consequences don’t harm us as much as they harm our patients. I sincerely hope that the next administration will view this issue with humility, but its past behavior makes me far from 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.