It’s Wednesday, March 6th, 2024. The day after Super Tuesday. I am sitting in the library, taking a break from writing a final paper for my health economics class, when I see a Politico article: “San Francisco’s Proposition F passed.”

3,000 miles away from my hometown and my medical school, all I can think about are the patients I served in the hospital who were barely surviving in the city. How many of them are going to lose their SRO now? How many are going to go without food? All because these services are now tied to drug testing.

And I cry.

I cry, thinking about how members of my community, whom I have wanted to serve through medicine since I was 15, are being harmed by the same city I love.

At the same time, I started seeing posts from my medical school peers back home, many of whom were similarly appalled. Then, I see that some exalt Proposition F as a big step forward for the city. Then, I see red.

We sat through the same lectures for years. We learned from the same experts who proved time and time again that the wars on drugs – exactly what Prop F is– only criminalized people and communities that the U.S. continuously marginalizes through policy, legislation, and systemic attacks.

How can the people whom I have witnessed provide so much care and empathy on the wards turn their backs on those same people now that they no longer occupy a hospital bed?

Arguably, I spend much more time thinking about politics and health policy than the average medical student. I applied to medical school with the intent to also earn an MPH focused on health policy. I see problems in medicine through different lenses and try to bring together the tools from both fields to understand and try to address systemic issues.

I constantly hear that medicine should not be political. I just want to practice medicine and not think about policies. It’s a good thing that there are people like you in medicine, I could never.

I hate to be the bearer of bad news, but physicians, collectively and individually, are directly responsible for the systemic violence and turmoil our patients face every day. The AMA was the original organization that pushed to criminalize abortion in the 1800s and advocated against forming Medicaid until it was passed in 1965.  In my home state of California, physicians sterilized Latina women in county hospitals without their consent for “population control” for decades. And we repeated this abuse in ICE detention centers in Georgia since 2017. The list goes on.

My point is not to make you feel guilty for being a physician. Quite the opposite. We hold immense power and trust that we should carry humbly. However, our white coat does not absolve us of wrongdoing, of abusing our power, and of betraying the trust of the people who need our empathy and care the most.

I want you to take an honest look in the mirror and ask yourself: how are you both helping and harming patients in and outside of the hospital?

Vaccine schedules are being torn apart, Black mothers are dying at an alarming rate, LGBTQ+ children are being murdered, and states are revoking medical licenses for providing standard abortion care. The people we choose to represent us in politics and the policies we support do not operate in a silo.

How is your vote making it harder for your patient?

How is your vote making it harder for you to practice medicine?

Reflect on these questions every time you create a discharge plan for a patient and realize they do not qualify for an SRO, so you have to choose between keeping them in the hospital for a few extra days or discharging them to the street. Reflect on these questions when your patient cannot afford to buy any foodstuffs, let alone ones that are “heart healthy.”

I have hope that medicine is still heading in a patient-centered direction. I see the lessons my late abuelito showed me while he navigated the health care system, in my peers and mentors regularly in the hospital: learn from patients, value their lived experiences, and to never forget that we are there to provide the best care we can, in whatever way someone needs. We cannot divorce policy and politics from medicine. The systems that we vote to maintain or change affect our patients’ lives. We see it on the frontlines in the hospital with every care plan, prescription order, surgery, and discharge plan.

I cannot tell you how to vote, and I would never want to discount your lived experiences and burnout, which led to your frustration with our current systems. I am asking you to analyze the greater impact these policies have on our patients’ lives.

Our profession preaches the gospel of practicing “evidence-based care.” That evidence must extend to how you vote in our electoral process and within medical societies. The evidence shows clearly that tying welfare dollars to drug testing solves nothing, criminalizing poverty solves nothing, and resurrecting failed policies from decades ago solves nothing.

Physicians and physicians-to-be cannot claim to be free from politics and policy anymore. We need to own our history. We need to apply the same scrutiny we have for research, evidence-based care, and presenting morbidity & mortality boards to our votes. Our careers are tied to every system that our patients interact with daily.

Vote like your patient’s health depends on it. Because, in the case of our most marginalized patients, it does.

​Elizabeth Picazo is a medical student.