During my (Kooser) recently completed psychiatric clinical rotation in a rural North Central Pennsylvania hospital, I witnessed many heart wrenching scenarios. As patients shared a wide range of traumas, their causes, and the impact on their lives, one question continued to nag at me: “How could the medical profession help people deal with such difficulties, and perhaps more importantly, help people to help themselves?”
One important intervention is not clinical at all: promoting programs and distributing information to empower patients to be civically engaged.
During this rotation, one patient in particular stuck with me. The attending psychiatrist and I were consulted by the internal medicine team for a patient who had type 1 diabetes with severe ketoacidosis. He had been life flighted to the hospital, with a blood sugar of 1,500 mg/dL. This patient had an established history of life-threatening medical emergencies due to not taking his diabetes medication, which prompted the psychiatry consult. As he was being medically stabilized with insulin and fluids, we attempted to talk to the man. However, largely due to the diabetic ketoacidosis, he was confused, inattentive, and unable to provide a comprehensive medical history.
Having received a very limited history from this patient, we decided to call his wife for more information. She was very tearful over the phone, relaying to us that when her husband was younger, he could not afford his insulin due to a lack of health insurance. When asked about the patient’s non-adherence to his medications, his wife stated in a trembling voice, “I honestly think my husband is just waiting to die. He is in so much pain from his diabetic neuropathy, that I think he welcomes death at this point.”
Hearing the patient’s wife discuss her husband’s pain was admittedly very difficult. During the conversation, I could not help but wonder how different things would be if the patient had better access to his insulin when he was younger, and his condition had been controlled before it advanced to its current severity. If this patient had accessible insurance and could have received his insulin at low or no cost, maybe today he would not be resigned to dying because of the pain.
Again, the question rang out to me: “How can such hardship be avoided in the future?” This encounter reinforced for me the need to empower patients to engage civically, such as by voting.
The Health and Democracy Index, which assesses 12 public health indicators and state voting policies, shows that states with less restrictive voting policies and more civic engagement are healthier. When patients are empowered to elect representatives that advocate for their best interests — such as greater healthcare accessibility, less economic disparity, and improved education, social services, and housing — patients and communities ultimately see improved health as a result.
Appreciating the connection between increased civic engagement and improved health outcomes, many health organizations are working to improve civic engagement within their respective communities. For example, Healthy People 2030 is working to increase the proportion of voting-age citizens who vote. While their target is having at least 58.4% of voting age citizens vote in federal, local, and/or state elections, only 52.2% of voting age individuals reported voting in these elections in 2022. Also, according to America’s Health Rankings, only 59.5% of U.S. citizens ages 18 or older voted in the last presidential and midterm national elections. Despite the established link between increased voting and overall public health, we still have a long way to go to increase voter turnout rates.
After the attending psychiatrist and I received the comprehensive medical history from the patient’s wife and we finished our day, my thoughts returned to the diabetic patient consult. In a follow up visit, we learned that he had been stabilized with insulin therapy and extensive fluid replacement. He was able to provide a more detailed medical history, telling us how excruciating his neuropathy was and admitting that he did not always feel it was worth enduring. We worked with the patient to arrange a follow up outpatient appointment, and ensured he was on proper medication for his diabetic neuropathy. Upon discharge, the patient appeared hopeful about the prospect of reclaiming his life.
Admittedly, as a busy medical student, trying to empower others to be civically engaged can prove difficult and exhausting. I must confess that I am often unable to stifle embarrassing public yawns. However, patients who are struggling serve as motivation to keep up the fight for increased civic engagement within the community. These efforts can take place both inside and outside the walls of the hospital.
Through the organization Vot-ER, I received a badge with a QR code that helps individuals register to vote. This badge is attached to my hospital name tag. Regarding the aforementioned patient, I was a bit apprehensive about offering to help him vote. With everything else going on, would this be too overwhelming for him? In the end, I didn’t bring it up to him out of fear of creating more stress. And that’s OK — we have to be mindful of the other things going on in patients’ lives. But when the right moments present themselves, understanding how civic engagement can help our patients is essential. This is top of mind for me right now.
With the upcoming election fast approaching, I do my best to take part in holding voter registration drives, and to help promote civic engagement while I am actively working in the hospital. By helping someone register to vote, that one person can promote greater healthcare accessibility that could ultimately contribute to improved health outcomes and quality of life for the entire community.
Julia Kooser is a third-year medical student at Geisinger Commonwealth School of Medicine in Scranton, Pennsylvania. She serves as the social media and outreach director for Civic Health Alliance, a nonpartisan organization working to promote civic health engagement and community mobilization in healthcare settings. Mysa Abdelrahman is a third-year medical student at St. George’s University School of Medicine in Grenada. She is an advocate for medical equity, women’s health, and global public health. Spoorthy Prabhudeva is a fourth-year medical student at St. George’s University School of Medicine. They are an advocate for civic engagement in the healthcare setting.
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