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Notes -
Did y'all talk about this story by Aaron Sibarium earlier this month?
Meet the Little-Known Activist Group That Has Tens of Thousands of Doctors Registering Patients To Vote
The article starts by describing a psychiatric institute in Pennsylvania that started an initiative to register voters.
Since the initiative is in a medical institution it must be justified, because you can't just waltz into medicine and decide voting is important. No, these institutes are bound to a sacred oath that commits their staff to the health of patients. By necessity, voting must become good for patients.
After the starting the voter registration initiative, the Pennsylvania hospital "has turned to the nonprofit Vot-ER, which develops "nonpartisan civic engagement tools" for "every corner of the healthcare system." This is where my lack of strong objection turns into a fully committed objection.
The basic gist is that medical staff wear a QR code around their neck and point patients to it in order to register. A 2021 executive order encouraged this behavior, but Vot-ER's site only cites the National Voter Registration Act of 1993 in its FAQ page as its legal reason to exist. Medical professionals have the greenlight to seek out patients and proactively attempt to register them to vote.
I did not vet every link in the article, but I did look at a few, and as far as I can tell most of the quotes are presented in a fair enough, if biased, context. There are professionals willing to say stuff like these bits:
I think if voting cures depression that's great, but I suspect voting does not cure depression and Debra Koss is not offering a medical opinion.
I watched most of a 20 minute talk from the founder of Vot-ER from 2023. It was very heavy on the voting aspect, the benefits of voting, and the benefit of voter registration. Not so much attention given to the medical aspect, ethical questions, or potential impacts. I briefly trolled through Vot-ER's site and, as far as I could tell, they don't provide any studies supporting the idea their program has significant positive medical benefits to patients. Which I would have figured would be necessary. If a doctor is doing something to me as a doctor it should improving my health.
If a person comes in with a broken arm and you offer to register them to vote on their way out I think this carries ethical questions but, fine, whatever. When the program extends to mental health institutions and picks up a motto of Voting Is Great For You Actually Because Anecdote this seems like it should be made an issue.
I'm no expert, but I am not under the impression that dedicating more attention to politics is the best path to a healthy mental state. I am under the impression that politics, particularly of the national sort, in this day and age appears to degrade many people's mental well being. Encouraging people to vote is not necessarily damaging to their psyche, but a focus on voting might be a gateway drug. An organization, staffed by party operatives or affiliates, pushing a political non-profits goals onto medical staff in hospitals is wrong.
Like ballot harvesting I think it's sleazy. I can accept sleaziness in politics. People accept that politics is not holy and sacred, but dirty. Importing it into medicine, which I know is not new, seems particularly bad though. Initiatives like this drives resentment when, on the other hand, I am inundated by messaging that claims one party is holy, good, and joyous democracy lovers-- while this party engages in what appears to be deeply cynical, irreverent electioneering. I guess I'll accept sleazy politics in medicine as well.
Time to kill some of my opsec. I have personally argued with Deb Koss at a conference in D.C. telling her to cut this shit out.
I won't say much about it but she (and others like her are) exactly as you'd expect.
It's not as worrying in the disciplines like Psych (hers), ID, and Peds where people are overwhelmingly left leaning but these advocacy people are still DEMANDING trainees participate in advocacy and politics (and it's always one specific kind of advocacy). Trainees who can't say no without negatively impacting their careers. It's gross and deeply unethical.
Furthermore these idiots seem fundamentally incapable of understanding how damaging this is to the long term health of the profession.
It's no different than any woke ideological capture but with a very damaging set up levers (ensuring incoming medical students are very left leaning, brainwashing them during vulnerable periods like residency, and mandating leftist political advocacy as part of educational curricula).
I hate it.
If it's any consolation, I'm sure right-leaning students handle this the way we always have: go through the motions, then make fun of it all behind their backs when we're hanging out on our own time.
But it is worrying. What separated us from the Soviets during the Cold War was you didn't have to be an activist to do things like medicine.
They do still exist but changes to the pre-matriculation "requirements" have decreased their numbers, and being "outed" as conservative or woke-questioning will kill your social life so they tend to be super locked down.
Add on the requirements to publicly go through the motions during times of profound stress and exhaustion.... you get people who legitimately convert or experience permanent changes.
Remember that medical school clinicals and residency is not far off from outright torture in a lot of ways and people get 1984'ed while going through this.
Salary and taxes walk some people over a few decades but it is less than it used to be.
Why do they torture students so?
A lot of things are going on here, some of which are a bit more complicated to get the full picture on like the historical issues with hierarchy and abuse.
Two simpler bits:
-You don't decide where you work and learn during training and if you leave, quit, or get fired you are done. Sometimes with upwards of 500k in debt. Programs know this and will mistreat trainees knowing they can't vote with their feet and their lives are pretty close to over if they don't suck it up. Suicides and deaths from things like sleep deprived car accidents aren't common per se but are frequent enough that we all know multiple people who went out those ways.
-Unlike most high education/high skill labor you need a lot of 24/7 coverage and physicians are very expensive and in high complexity specialties like surgery you have to do a FUCKING LOT of stuff to become independently proficient in a reasonable number of years. The solution is typically to rely on trainees and long hours. On paper Residents aren't allowed to work more than 80 hours a week, must get at least 4 days off in a month, and aren't allowed to work more than 24+4 hours in a row. On paper. Very common for people to violate one or more of those in an easy specialty at an easy program. In something harder like procedural specialties? You might work 80-100 hours a week with an average of four days off a month.
For 5 years.
Shockingly!!! Substance abuse, mental illness, and medically measurable premature aging (fun study that one) are rampant.
This breaks people down and I think could be reasonably considered torture.
Add on the fact that you can't leave, and many other aspects of the training can be considered abusive (said things that are a bit harder to explain)...
Wow I had no idea the state of medicine was so bad. Jesus.
So are you saying that the state of residency is sort of justified by the difficulty of the profession?
How would you do it differently if you had the magic wand of 'fix up the medical training system'?
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Plenty of other crap is going on and much of that presents easier targets - excess regulatory burden, administrative overreach, wellness modules, U.S. malpractice environment, etc.
A large swathe of the central problem is that Americans doctors are expensive (so hiring more staff for instance is...difficult) and at the same time Americans won't work in American healthcare without those salaries (because of things like the American patient population, malpractice and so on). It makes bigger fixes extremely hard.
Many kinds of surgeons are just fucked - medicine has improved, which means we do surgery less often and the types of surgeries we do are more complicated and harder to learn. It's an order of magnitude or more easier to learn how to remove something from an option approach (think just cutting someone open) than a laparoscopic approach but the latter is much much much better for the patient. Finding ways to make this not extend training time is a nearly intractable problem.
However, a sensible target is malpractice insurance. Doctors do fuck up and do fuck up in ways that should involve penalties but functionally these seems to be entirely separated from who actually pays and gets penalized in our current system. Malpractice insurance alone for OB can be over 150,000 dollars a year. That's insane.
Stronger unions for residents and attendings is probably also a good idea. Unions can absolutely be bad but we are far off from the point where that's an issue.
Likewise kill some various forms of rent seeking and other bad behavior like egregious non-competes, physician boards that costs of tens of thousands of dollars, substance abuse programs that also costs tens of thousands of dollars if you somehow manage to get caught smoking weed, etc.
On a structural level you can probably free up money that can be use to improve healthcare and reduce burden on doctors by targeting various middlemen and administrative horseshit. Fire the front desk staff to pay for an extra useless diversity or infection control administrative and the doctor just adds that job to the list of things they do.
Walk that back, the ratio of clinical to administrative staff is insane and grows worse every year.
I'll try not to blather too much but however bad you think it is it's a lot worse. A classic example is the fact that the population of people we've selected to be doctors might be offered the option of working in NYC or getting paid 300k more a year to work 2.5 hours to the northwest and they'll pick the city. Shit's fucked.
Sidebar: 24+ hour shifts were taken away and then brought back because most people (including residents) thought they were better than the alternative. Which sounds insane and is.
Wait but you were saying earlier that it's hard to hire people and doctors need more support because it's expensive. Wouldn't the admin staff help with this??
Oh trust me I am pretty severely blackpilled on the Western medical institution, although I do admit that modern medicine has miracles aplenty. My mother's life has been saved on three different occasions by relatively recent medical inventions. So I'm grateful.
But I also wasted over $20k in my early twenties trying uselessly to figure out my chronic pain issues with TMJ, sciatica, RSI, and other various health stuff. Was told by multiple doctors I'd need surgery if I ever wanted to use a keyboard and mouse again. I'm pretty close to recovered now but... anyway that's a story for another day lol.
I didn't realize they were taken away! Ugh yeah it's so fucked. I've seen studies on like the efficacy of doctors based on how long they've been on shift and it's terrifying. Going to the hospital seems like such a crapshoot luck of the draw type situation in some respects.
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