At times, I want to give up this crazy, broken career as an emergency physician. We all recognize that our jobs have become more challenging since COVID-19 broke down our health care system and destroyed many of our social safety nets. COVID-19, vaccines, and health care in general have become more and more politicized, and I think that anyone who continues to deny the role politics and policy play in the health of our patients is intentionally missing the elephant in the trauma bay.

Observations on Shift and on the Street

I see the consequences of political decisions and policies. The elderly woman about to lose a foot due to complications of her diabetes? She is unable to afford the monthly cost of her prescription medications, despite having insurance and having been employed her entire adult life, and so rations her insulin. Teen pregnancies, recurrent sexually transmitted disease exposures and infections, injuries due to intimate partner violence? Data clearly suggest that abstinence-only sexual education in our public school systems has resulted in astonishing rates of teen pregnancy, abortions, and sexually transmitted disease infections.^1,2

The most dramatic example of the interplay between politics and medicine is the ever-increasing gun violence in my home city, Philadelphia. 2021 was a remarkably violent year in the city—there were more than 550 homicides, 85 percent of which were due to shootings.^3,4 There was a total of more than 2,300 shootings in the city in 2021—that shows up in the trauma bays and resuscitation rooms in our emergency departments.

A resident once said to me that in emergency medicine, “we carry our graveyards with us.” Well, unfortunately my graveyard is bursting at the seams. Eventually, they chip away at our ability to work in this field.

Doing Something Different

In a moment of burnout, desperate to continue as an emergency physician, and needing to change something, I signed up for a civic health fellowship through Vot-ER.⁵ Vot-ER is a nonpartisan organization that works to bring voter registration into health care settings, with the goal of giving patients a voice in the policies that directly impact them. This fellowship has reinvigorated me and given me a way to funnel my anger into action.

There are 51 million unregistered voters in the United States, the vast majority of whom are young, low-income people of color—a huge chunk of the patient population that we serve on a daily basis.⁶ When patients do not vote, political campaigns are less likely to address their needs. In Philadelphia specifically, neighborhoods with higher voter turnouts have higher life expectancies in comparison with areas with lower voter activity.⁷

Our patients desperately need their voices heard by those in political power: they need political action and policy that will address gun violence, crime, education, access to health care, and countless other challenges that negatively impact their health. Using the tools learned in my fellowship, we have had tremendous success registering our patients to vote. We have run educational sessions for our emergency medicine faculty and residents to present the concept of voting as a social determinant of health, and teach methods and strategies for registering patients in an emergency department setting. Vot-ER has provided us with badges printed with QR codes, which patients can scan and check their voter registration in real time. We have worked with our registration staff, and have successfully integrated a voter registration prompt into the emergency department registration process. We have also added a voter registration QR code to all discharge instructions printed from the emergency department.

In the fall of 2022, we organized and ran a city-wide voter registration day in health care centers across Philadelphia. Working with colleagues in other hospitals to set up a unified event was an incredibly energizing and satisfying project that helped reinvigorate and inspire me as a physician. The health care field can often feel very competitive, especially in academia. This event, though, was a true collaboration to help the underrepresented patients of Philadelphia. We worked across five major academic institutions to co-run voter registration drives at our hospitals and clinics for National Voter Registration Day in September. At my hospital alone, we registered nearly 50 new voters in this single event.

We have expanded our project from last year, and plan to include more clinics, hospitals, and medical schools. Please consider planning an event at your hospital–you may be surprised at the amount of support and satisfaction you receive.

Impactful Work … Everywhere

In some ways, this feels more impactful than a lot of my clinical work. I can fix the electrolyte derangements and acidosis of my patient presenting in diabetic ketoacidosis, but I cannot fix the social issues that led to their near-monthly hospital presentations for the same issue. However, by empowering the community to participate in our democratic process, hopefully systemic change can occur and help make our country a healthier place to live. This has re-inspired me as a physician, and has helped me find meaning and purpose in the often heartbreaking reality of our profession.

Dr. Abramoff (@CLAIRENTO) is an assistant program director at Einstein Medical Center in Philadelphia.

References

1. Stanger-Hall KF, Hall DW. Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S. PLoS One. 2011;6(10).
2. Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Health. 2008;42(4):344-51.
3. Beatrice Forman. A hard look at the numbers behind 2021’s record gun violence in Philly, and an overview of what’s being done. BillyPenn newsletter website. Published January 10, 2022. Accessed August 10, 2023.
4. American Academy of Family Physicians. Gun violence, prevention of (position paper). AAFP website. Published 2018. Accessed August 10, 2023.
5. Healthy communities powered by a healthy democracy. Vot-ER website. Accessed August 10, 2023.
6. How does gun violence impact the communities you care about? Everytown for Gun Safety website. Updated February 2023. Accessed August 10, 2023.
7. Pittel H. Elections: voter turnout varies between wealthy and impoverished neighborhoods. Philadelphia Neighborhoods website. Published July 3, 2019. Accessed August 10, 2023.