By Elizabeth Kravitz and Larry Kravitz, MD
We are two generations of primary care providers. The father, a family physician, is in his 42nd year of medical practice. The daughter, just beginning, is a fourth-year medical student at Baylor College of Medicine pursuing obstetrics and gynecology. We are at opposite ends of our medical careers, but we collaborate on our health care perspectives more than we clash. Today, we share my daughter’s view of a physician’s role in promoting democracy.
I am a physician-in-training, and I am also a public servant. I became a Texas Volunteer Deputy Voter Registrar, and in Texas, my capacity in that role is to facilitate and assist in voter registration in a nonpartisan manner. At first glance, these professional responsibilities appear mutually exclusive: a primary care provider and a state-deployed volunteer. However, I challenge you to reflect on how these two responsibilities are convergent and compatible.
In medical school, we are taught the “social history.” We inquire of our patient’s lifestyle, food security, work, housing, safety, education, and more. We address these social determinants of health in the exam room. As a VDVR, I address these components with the citizens of Texas. I encourage citizens to utilize their right to a voice in the policies that affect these components of their daily lives, and consequently, their health. This year, in the setting of a global pandemic, with hundreds of thousands of casualties in the United States, this necessity of civic engagement is only heightened. And so, I have departed from the antiquated design that separates medicine and policy — the two are inseparably entwined.
Health disparities affect access to the American democratic process. Using information from the U.S. Census Bureau, about one in seven of those registered to vote in 2008 listed illness or disability as their main reason for not voting; the rate is even worse in lower income populations.
In the summer of 2020, I endeavored to offer voter registration forms to patients at clinic sites. The necessity of health care makes patients accessible at their appointments, and they can register to vote at the same time. The average waiting room time for a patient is listed as 18 minutes, and many initiatives exist to make productive use of this opportune free window along with other stagnant moments in the course of a patient’s encounter with the health care system. Why not voter registration?
I enlisted medical students, residents, attendings, nurses, attorneys, and other patient advocates. Together we navigated our way to the executive board of the Harris County Health System to eventually gain not only approval, but a small grant to pilot a program to demonstrate the necessity of voter registration outreach for our patients. As patients exited the clinic, they were provided the opportunity to fill out a mail-in voter registration form, with a mail bin located nearby for easy submission — in the end registering approximately 900 patients at two clinics over the course of a month.
There is precedent for physician involvement in voter registration, such as this one. The National Association of Community Health Centers, a nonprofit association of health centers, completed voter registration for more than 18,000 people at community health centers in 2008. These activities must be normalized among physicians, as we have an expansive responsibility to facilitate these opportunities for our patients.
The political climate and infrastructure of Texas are imbued with innumerable obstacles to voting, and as physicians and physicians-in-training, we may feel ill-equipped to advance into this space. But in these obstacles is the heart of our work and passion: Advocacy is the nature of a physician. Communication is the nature of a physician. Teamwork is the nature of a physician. Decision making is the nature of a physician. We are both compassionate and objective, and we spend our lives learning to balance our warm humanity and ideals with the cold limits of our physical realities. At all the life stages of our careers, being this person is our identity. And this training needs to also be brought to a bigger stage — to the stage of politics and policy.