Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
One of the penalties for refusing to participate in
politics is that you end up being governed by your inferiors.� � Plato (427
BC - 347 BC)
Today�s world faces problems that are complex and
complicated. The field of medicine is showing rapid progress with new
discoveries, policies and paradigms [1�4] and seeing new challenges which
require new and rapid responses. Consequently, medicine and healthcare are
being increasingly turning into a business .
Despite progress in many areas, there are certain key
sectors within medicine that are chugging along rather slowly. We don�t seem to
have answers to medical politics and questions like:
On what basis was the government acting with regard to issues of
Why is my treatment not covered by government or insurance?
Why is the funding cut for specific procedures?
Why are resources being allocated for something we don�t all agree upon?
On what basis was the funds divided amongst all the different parties
and how on earth did they get all that funding and space when they do not seem
to have the required workload?
How on earth did he get elected to that position over several more
competent and credible candidates?
These are the all too familiar grouses heard amongst the
public, physicians, ancillary staff and the administration. Everyone blames the
politicians even though we really do not understand how the system works. Is
there a better way to deal with controversial biomedical issues confronting us
today? Can we anticipate the forces that will emerge on the various sides of an
issue better, or are we destined to muddle through and institute policies
incrementally and contentiously? 
Politics is often associated with dishonour and corruption
because that is how it is frequently practised. The unfortunate truth is that
political pressure has been imposed to alter scientific reports on everything
from the environment to occupational health, and racial disparities in health
care . This is not as shocking as it seems. After all, we do manipulate in
our daily lives and in politics, the level of manipulation is just a lot more.
As much as we would like to deny it, medicine is not
immune to politics! Few of us in biomedicine want anything to do with politics
because it is messy, chaotic and disordered, a far cry from the world we have
been trained in. Politics, unlike medicine, is not evidence-based. Physicians
and scientists believe they operate in a rational world, one in which
interpretations and predictions are based on objective data and evaluated
through a systematic process . However, it would be a fallacy to assume they
are without group-think and peer pressure.
Why the need for politics? The reason for all the
jostling, manoeuvring and strategising is that there is never enough to go
round for all the interested parties. The pie has to be divided and not
everybody gets their share of it. While collective decision making is a
solution, the desire to push individual agendas using every available means.
This serves as to influence the decision making process and operates as
political pressure. The decision-making can either occur with openness and
honesty, or with subterfuge and dishonesty. In the latter case we are tempted
to accuse: �Politics!� . Sometimes the interests of all groups can be
advanced although often, rigid deadlock occurs with little movement in any
direction  no progress or benefit to any party. We therefore liken politics
to a process by which a group reaches a decision .
Success in the political realm is no different from
success in medicine, business or any other venture. Defining success may really
be a question of looking at it in the context of time, place and circumstance.
Therefore, a useful strategy for examining decision making is to separate the
outcome from the quality of the decision process .
Leaders must indeed create ideas and carry policies forward, but always
consulting the led, creating buy-in and sense of being part of the process from
those you lead. Followers may desire results with the least effort, sacrifice
and contribution but maintain the right to complain and criticise when
leadership is short on the delivery .
Leaders are judged by how they spend their time, how they react to
critical incidents, the stories they tell, the questions they ask, the language
and symbols they choose and the measures they use .
The operative word is 'networking.' If one wants to achieve lasting
success in business, organised medicine or raising show dogs, one must build a
network of people with similar interests" .
You also need to be able to negotiate and sympathise with both sides of
the argument and achieve an acceptable compromise. However, this should not be
overdone and become Machiavellian, where political expediency is placed above
morality, craft and deceit used to maintain authority and carry out the
policies of a leader but rather ensuring that one�s skills are applied to
Without your feet firmly on the ground and your shoulders able to hold
your head, power and position can be addictive. Medical politics is as
dangerous and habit-forming a drug as any benzodiazepine, and the sensible
medical politician should have a level of self awareness to realise when
participation has become self serving . The position itself becoming the
prized possession and no longer the possibility of bringing on change or the
perceived good leadership is supposed to drive.
Provide opportunity to those under your wing to grow and experience new
learning. To quote Horace �no man ever reached to excellence in any one art or
profession without having passed through the slow and painful process of study
and preparation� . As with most other pursuits, most of us learn by doing,
and medical politics also requires an apprenticeship. The process from the
beginning to the top may take decades as it may be intimidating, boring and
even scary. Unless more of us take a turn in medical politics, our
organisational life will wither, or worse, be left in the hands of political enthusiasts.
Constantly �reinvent� yourself, staying updated on new developments, by
learning from and responding to your environment. It is only by consciously
breaking away from our own safe and comfortable paradigms and experimenting
with new ones, from books, travelling, talking, arguing etc. can we bring a new
perspective to our stories, add value to the lives of others and develop a
different dimension. It is often a fear of failure that holds us back. But by
stepping back a little and giving ourselves the time to think and analyse and
learn, we avoid the rut.
Do not to isolate yourself from your associates as you may end up being
the one talked about, or blamed for miscellaneous, trivial problems. You also
miss out on the real news in an organisation.
Always ensure that one�s actions are based on the highest levels of
moral practice, i.e. integrity, humility and leadership.
Success has a price, even though we may find it difficult
to determine with certainty what the true costs are. What are all the costs
associated with success in medical politics?
Involvement in public life takes away some of your most valuable
resources at our disposal, professional and creative time.
Personal and professional practice is often strained because of
competing priorities in a week.
The toll is not only on yourself but our immediate families and friends,
the organisations you work and in instances, the very patients you set out to
protect. The emotional wear and tear on the individual with moments of anxiety,
embarrassment, and rage tends to accumulate over time. It is not uncommon to
see episodes of euphoria interspersed with longer periods of melancholy.
When you finally decide to throw in the towel, you may find it hard to
let go. Depression, anger and disgust are not uncommon and you may forget all
the good things that have been done. This is especially true if the change-over
has been filled with lots of turbulence, acrimony and �death to the end�
battles. Sometimes you may even resent the successor, even if he or she is of
your own choosing.
If you lead or have been involved in many organisations, perhaps the
best time to go is early on your prime, when you are still at your best. Set
yourself a target of number of years or specific objectives and leave once that
is achieved, with a good feeling. Do not wait until the politics of the organisation
drive you out. Your supporters will always tell you are the best man for the
job and that no one has your vision and your drive, but don�t fall for that!
Most of them also carry vested interests and may be afraid of change.
Rubbing shoulders with the powerful and influential adds to the sense of
worth and purpose in being in the thick of regional, national and international
decision making. Make sure you can handle it.
Even though Osler found health policy to be dull, eschewed
political action committees as undignified and advised physicians to shun
politics, there are those who believe that in today�s practice this laudable
philosophy limits the health policy potential of the doctor-patient
relationship . The price of a physician�s closeness to his patients� needs
and experiences is to assume responsibility to look after their interests. An
effective form of advocacy available to every physician is education: infusing
health care policy into patient health care maintenance. Patients, who are
voters, must be empowered to shape the local and federal policies that directly
influence their healthcare.
In addition, there are those who go so far as to say that
politics and management are obviously related. Management is the applied
science; politics the high art. Political experience and training are the best
introduction to management. The art of identifying what is possible and
eliciting the best out of people is the basis of both . One of these
efforts is to frame policy issues as technical management questions [15-17]
that are then best resolved by experts chosen based on merit. They hope to
defang political conflict by appealing to evidence and expertise and search for
a technocratic fix. The extension to this is that with evidence-based medical
information, better clinical decisions, medical care, and health policies can
be made without controversy or politics. And physicians, the public and
governments will be able to rise above their parochial views and self-interest.
However the nature of policy making is such that choices need to provide value
and cannot be reduced to technical issues. It is not possible to purge issues
of value, purpose, or politics from public policy. In fact, defining challenges
in such a fashion masks the underlying political disputes. Battles over income,
turf, and the goals of medicine and policy lie just below the surface. Under
these circumstances, evidence can become an instrument of politics rather than
a substitute for it .
Politics should be recognised, brought to the fore and
included in training programmes for both medicine and research. The BMJ and The
Lancet are trying to provide this by believing that serious medical journals
should examine not only the immediate, but also the underlying causes of
disease and premature death, which inevitably involve political issues [19-21].
To concentrate on the immediate causes, while ignoring the social and political
factors underlying ill health, is in itself a political decision, after all
�politics is nothing but medicine on a grand scale� . It is also important
to incorporate external political and human rights contexts into research
ethics codes or ethics reviews. The balance of risks and benefits, the
assurance of rights for individual participants, and the fair selection of
research populations can be affected by the political and human rights
background in which a study is done .
How do we go forward? Decision making is difficult when
the members of the group do not trust each other, or feel secure. Politics can
proceed in an atmosphere of trust, security, and knowledge, or without those
benefits. In the former case, better decisions may be reached; they may not be
perfect and they are unlikely to satisfy everyone, but they are not reached in
an atmosphere of subterfuge and mistrust. And this itself may influence
everyone concerned to surrender gracefully . It would be exciting and
gratifying to see some evidence-based politics in the health service sector .
A well lived �political� or �public� life has benefits for
both the individual as well as to society at large. For the individual, it
enhances reputation and respect, allows acquisition of the language and
techniques of management, contributes to wider and better decision and policy
making, the satisfaction of changing direction, focus, enhancing lives. It has
been said that �A management course or two has become de rigueur for the
sleek CV, but real organisational work is to management theory what making love
is to a sex manual: both are interesting, but the practice is the more
fulfilling experience� .
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Received 9 December 2006; accepted 21 February 2007
Correspondence: Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Tel.: +603-79492069; Fax: +603-79581973; E-mail: firstname.lastname@example.org (BJJ Abdullah).
Please cite as: Abdullah BJJ, Ng KH,
Medical Politics 101, Biomed Imaging Interv J 2007; 3(3):e13
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