Editorial Vote Like Our Patients' Lives Depend on It Brent K. Sugimoto, MD, MPH, AAHIVS, FAAFP

Brent K. Sugimoto, MD, MPH, AAHIVS, FAAFP

We family physicians would do anything for our patients. We leverage the breadth of our training to ensure our most vulnerable patients get access to the services they need. We take the time to build relationships with our patients and their families so that our care is personal and patientcentered. Family physicians are right there at the moment of birth, and many times are there to ease the end of life. Can we assume that we do everything in our power to assure the best outcomes for those we provide health care? If you analyze the data, we fall short in two important regards. Not enough of us vote, and not enough of our patients vote. Electing our representatives is a basic way to influence policy priorities that impact our patients’ health, such as pandemic preparedness, vaccine funding, residency funding, and health care programs like Medi-Cal. Voting is vital to protecting patient rights, especially those under assault like access to abortion and gender-affirming care. Exercising the right to vote may be the most direct means many of us have to protect our communities from gun violence. Without exercising our franchise and encouraging our patients to do the same, we are neglecting a powerful tool in our family medicine arsenal. Even though voting is a health care issue, it has long been observed that physicians have a poor track record when it comes to voting. Consistent with past studies, Ahmed and Chouairi (2022) found in the 2020 U.S. Census data that physicians were less likely to vote compared to the general population. In general, the likelihood a physician will vote is correlated with age, with Millennials being the least likely to exercise their franchise. The most commonly cited reasons for failing to vote included not being registered and being too busy or having a conflicting work schedule. The most common reasons for not registering were missing the registration deadline and a professed uninterest in politics, (Ibid, 2022). I believe that an “uninterest” in politics is an unstated part of medical culture, rooted in the well-meaning intent to be unbiased fiduciaries to our patients. However, this attitude conflates political engagement with partisanship, which many of us would hesitate to bring even to Thanksgiving dinner, let alone the exam room. Political engagement, however, allows family physicians to educate legislators about the needs of our patients. At its most basic level, it begins by electing those lawmakers who understand our patients’ health needs. Voting is the first step in crafting sound health policy. Beyond our own voting habits, exercising the right the vote should be a regular part of health education to patients. Our counsel to vote is one way patients can get their representatives to address shortcomings in our health care system. Dr. Manisha Sharma, a California family physician and co-founder of Civic Health Alliance, has been one of the leading voices championing voter registration drives in health systems because of the recognition that those communities with the worst health disparities also happen to be the communities that vote the least. (Voter registration is legal in public and private non-profit health systems—and even required in FQHCs with government employees—when done in a non-partisan manner) Because of voices like Dr. Sharma’s, the house of medicine is finally starting to recognize the importance of helping our patients vote. In June, the American Medical Association updated its policy to declare that “voting is a social determinant of health and significantly contributes to the analyses of other social determinants of health as a key metric.” At the 2022 Congress of Delegates, the AAFP resolved to support mail-in voting options for any reason in elections at all levels in order to reduce health disparities, because those with the poorest outcomes are the least likely to vote. Medicine still has a ways to go (for example, a group of us continues to advocate that the AAFP support voter registration in health systems to improve health equity), but I am encouraged by recent progress that we can go further. As the midterms approach, register to vote if you haven’t already and please encourage your patients (and peers) to do the same. We must vote like our patients’ lives depended on it.

For resources to help you get your patients (and colleagues) registered to vote, Civic Health Alliance has guidance and materials to help you get started: https://www.civichealthalliance.org/resources

The Centers for Disease Control and Prevention (CDC) recommends that everyone between the ages of 13 and 64 get tested for HIV at least once and that those with ongoing risk be screened at least annually. Yet 1 out of every 8 people in the United States are unaware of their HIV status. You can play a critical role in ending the HIV epidemic by offering HIV screening to all your patients. Routine HIV screening helps to:

• Reduce HIV transmission by empowering your patients to know their status. • Improve your patients’ health outcomes by linking them to prevention or care services. • Eliminate stigma associated with HIV testing by making it the standard of care.