Working in hyperpolarized environments threatens quality of orthopaedic care

Jonathan Dubin, MD, FAAOS, and Ajay Srivastava, MD, FAAOS

There is no denying public American discourse has recently been marred by hyperpolarization. Affective polarization, defined as “the tendency of people identifying as Republicans or Democrats to view opposing partisans negatively and co-partisans positively,” has been on the rise since the early 1990s. Similar patterns can be observed regarding sexual orientation and religious affiliation. The causes are myriad but include a constant barrage of reaffirming feedback on social media and the creation of an “in-group” versus “out-group” mentality. The end result is increasingly frequent uncivil discourse in workplaces and diminished trust among colleagues.

Unfortunately, showing up to work with a polarized mindset can negatively affect working relationships among coworkers and has the potential to harm patients. Although two-thirds of Americans claim it is important to get along with people with whom they disagree, almost 40% admit to changing an opinion about a coworker because of political affiliation and 30% report that political differences affect work productivity. A report in 2019 showed that among a cross-section of 25 countries spanning six continents, 51% of respondents from the United States believe their country is “at more danger compared to 20 years ago” because of political divisions. As medical professionals, we are not immune to these divisions, but it is critical to leave political and social biases out of our work. We should strive to foster cordial and collaborative relationships with all members of our care team so patient needs are always placed first.

Nurses, physicians, and healthcare workers remain the most trusted sources of information to improve health for both Democrats and Republicans. However, some forms of controversial political expression are becoming more prevalent, especially at medical schools. No matter how well intentioned, simple actions can be triggering or offensive to others. For instance, wearing pins that support political affiliations may create tension and erode trust between coworkers. Furthermore, physicians, residents, and even medical students posting or sharing inflammatory rhetoric on social media could gain attention at an institutional or even national level, potentially resulting in investigations, demotions, or terminations. Online groups and chat platforms intended to connect people with similar interests also have seen an increase in polarizing and divisive political posts. This may lead other members of these groups, who may be professional peers, to feel isolated, frustrated, and even targeted.

Although freedom of expression is a constitutional right, physicians may compromise professional and moral obligations to patients when they allow political beliefs — and, occasionally, political agendas — to impact a collegial and collaborative workplace environment. Instead, as physician leaders, we must set an example by focusing our energies at work on individual patient care by engendering an inclusive environment. Other times, places, and media can be found to express deeply held political beliefs. Physicians also must realize that their actions outside of work, whether they like it or not, can influence their interactions at the hospital. Just as athletes’ remarks, whether planned or spontaneous, can spread widely and impact their careers, physicians’ statements can quickly circulate within their professional community and lead to workplace consequences. Occasionally, hotly debated political issues, especially those affecting our patients, may benefit from or even require discussion at work. Examples may include topics related to healthcare access, public safety, and certain diversity and inclusion initiatives. Braver Angels, a group dedicated to bridging the partisan divide, recommends expressing opinions constructively, then listening intently to alternative perspectives without leaping in to contradict. The group also emphasizes the importance of avoiding polarizing language, authoritative statements, and labels, such as “right-wing” or “leftist.”

As physicians, our primary job at work is to treat the individual patients under our care. Healthcare professionals should refrain from unnecessary expressions of political beliefs that can undermine this mission. When indicated, discussions involving contested political issues must include only constructive comments, active listening, and depolarized language. Delivering the best care to patients requires a foundation of teamwork that is built upon interpersonal trust with colleagues. This is established only through acknowledgement, respect, and empathy.

Jonathan Dubin, MD, FAAOS, is an associate professor of orthopaedics at the University of Missouri–Kansas City Medical School and serves as chief of orthopaedic trauma at University Health–Truman Medical Center, Kansas City, Missouri. He is a member of the AAOS Committee on Healthcare Safety.

Ajay Srivastava, MD, FAAOS, is an adult reconstruction surgeon and director of the McLaren Flint Orthopaedic Surgery Residency Program at McLaren Flint Medical Center and Hurley Medical Center in Flint, Michigan. He is a member of the AAOS Committee on Healthcare Safety.

References

1. Iyengar S, Lelkes Y, Levendusky M, et al. The origins and consequences of affective polarization in the United States. Annu Rev Polit Sci. 2019;22:129–146.
2. Javidan M, Cotton R, Kar A, et al. A new leadership challenge: navigating political polarization in organizational teams. Bus Horiz. 2023;66:729–740.
3. Ipsos. BBC global survey: A world divided? Available at www.ipsos.com/en/bbc-global-survey-world-divided. Accessed January 2026.
4. Barber B, Blake DJ. My kind of people: political polarization, ideology, and firm location. Strateg Manag J. 2024;45(5):849–874.
5. Findling MG, Blendon RJ, Benson JM. Polarized public opinion about public health during the COVID-19 pandemic: political divides and future implications. JAMA Health Forum. 2022;3(3):e220016.
6. Zitner A. Meet the Americans trying to lower the temperature in politics. Available at: www.wsj.com/politics/meet-the-americans-trying-to-lower-the-temperature-in-politics-062086eb . Accessed January 202