Next Generation is a Brigham Clinical & Research News column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, email us. This month’s column is written by Kelly Schuering, MD, an Internal Medicine resident, and a member of the VoteRx team at the Brigham.

Kelly Schuering

Kelly Schuering

My patient, who identifies as queer, reported feeling more anxious at their clinic visit last week. Their worsening anxiety was driven by both the increasing numbers of COVID cases in Massachusetts and fear that their rights may be affected by the results of the imminent election. We discussed utilizing their voice through voting as a productive response to their anxiety and how to be as safe as possible while voting early with their wife in the upcoming days.

Though many physicians feel uncomfortable with such conversations about voting, I believe that encouraging civic engagement amongst my colleagues and patients is an essential part of my duty to promote the health of my patients and community. Only by hearing as many voices as possible, especially those who are traditionally disenfranchised or otherwise silenced, can we hope to together build a society that best meets the health needs of every person.

In June, my friend and colleague Vishal Arora, MD, suggested voter registration drives to encourage political participation as a response to the murder of George Floyd. We quickly linked forces with Brigham Residents Julia Jezmir, MD, MBA, Max Coll, MD, Jessica Stuart, MD, the MGH team of Sejal Hathi, MD, MBA, Radhika Jain, MD, Celeste Peay, MD, JD, Jake Fox, MD, Harvard medical student Jon Kusner, and other colleagues to grow the VoteRx team with the goal of getting as many people as possible to the ballot boxes.

As physicians have been found to have lower voter registration rates and lower odds of voting, we first decided to focus on ensuring that it would be as easy as possible for the new interns joining the Brigham family to register to vote. Outside of scheduled Epic trainings, we welcomed the new interns, asking about registration status and helping to complete and mail the paperwork for those who wanted to register in Massachusetts. In just a few afternoons, nearly every eligible internal medicine intern had been contacted to ensure that they would be ready to participate in upcoming elections. This success left us energized — how many more people could we reach?

Vote wall cling

Wall cling display in the lobby of 75 Francis St

Over the next few months, the VoteRx team worked on a variety of projects to increase voter mobilization: badge backers with QR codes to registration links, partnering with the Office of Strategic Communication on posters and publicity, and continued outreach across the hospital to trainees, faculty, and staff. As time passed though, current events continued to remind me of what had prompted me to work on voting efforts in the first place: seeing the inequities and injustices so many of my patients face on a day-to-day basis.

In medical school, I spent a lot of time working at Shade Tree Clinic, Vanderbilt’s student run free clinic, helping care for the uninsured across Nashville, Tennessee. In the lives of my patients at Shade Tree, I so clearly saw the effects of a poor public transit system, food deserts, and most of all, the state’s refusal to expand Medicaid. When I chose to go to residency in Massachusetts, I thought many of the challenges my patients faced would be better, if only as a function of having health insurance.

I quickly found out just how naïve that expectation had been. The COVID pandemic, in particular, revealed this as our ICUs and wards filled up with patients who had little option but to go into work to feed their families despite their inability to social distance at home. Continued news reports of murders of black men and women at the hands of police, forced sterilization at immigrant detainment centers, and worsening food and housing insecurity with rising unemployment rates kept injustice at the forefront of my mind. I often felt powerless as I witnessed vulnerable populations, including my patients, continue to struggle and even die under the disproportionately heavy weights of social inequity.

And yet, I remind myself that I am not voiceless or powerless. As an American citizen, I have the ability to vote to help bring about the society I hope to see. As a physician, I have the ability to use my position of privilege to advocate for the needs of my patients. And most importantly, I can magnify this by helping others — both my colleagues and my patients — to use their voices as well.

Research shows that self-rated health is higher in states with less disparity in voting turnout by socioeconomic status. With this in mind, VoteRx shifted our efforts to be more patient-facing with a focus on the most vulnerable. This included preparing information for patients’ clinic after visit and hospital discharge summaries, expanding publicity into clinics and wards, and most importantly, focusing on direct conversations with patients, while coaching our colleagues to do the same. By encouraging patients to use their voices through voting, we begin to acknowledge our country’s long history of suppressing voting among those who most stand to benefit from an improved social safety net and move beyond paternalism.

Discussing voting with my patient reminded me of my commitment to continue to work for greater social justice, led by the voices like my patient’s that society tries to silence. And, I can only hope it communicated to them, “I care, and we — as healthcare providers and as a society — need to hear your story and your voice to do better.”

Vote. Let your voice be heard. The health of our democracy, our community, and my patients depends on it.

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