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I Want To Make a Difference

JeffJeff Wonoprabowo -- I'm worried about how I feel about the upcoming November Presidential elections. I'm worried that I will be so frustrated that I decide not to vote.

At the moment, I'm not sure who I'm going to vote for. This coming election may very well be the first presidential election I vote in. But I can't stop feeling like my vote won't matter. That's why I didn't vote in 2004. And that may be the reason I have lost some of my excitement about this election.

For all the talk of change during this election season, how much change can my vote bring about? I don't live in a swing state. I live in the Golden State. It's a state where McCain doesn't have much of a chance of winning the 55 electoral votes.

It doesn't really matter who I vote for. Whether I vote for Obama or McCain, California will still send its 55 votes to the Democrats (I've heard that California is considering giving its 55 electoral votes to the candidate that wins the popular vote). The sense of my-vote-doesn't-matter is not encouraging.

That worries me. Because while thinking about this political situation, I started wondering about a medical one. In a course called Understanding Your Patient, we learned about teaming with our patients to bring about change -- change in behavior, diet, lifestyle, or even just taking medications. Compliance, our professor told us, sounded like a word that a ruthless dictator might use. Doctors shouldn't be forcing change upon patients. Lasting change requires a patient to decide that change is what he or she wants. Teaming with our patient is the most effective method to bring long-lasting results.

But what happens when I have a patient who is non-compliant? What happens when my 55-year-old patient with 40 pack-years refuses to quit even though the biopsy comes back positive for lung cancer? And what happens when I get a patient desperately needing a liver transplant who cannot get over his drinking problem?

When I inevitably find myself in a hopeless situation because a patient cannot or will not follow the healthcare plan, then what?

It'll be a situation where my "vote" means nothing. And I'll feel frustrated, I'm sure. In the political arena, I am considering not voting. In the medical arena, I'm not sure what I'll do because I've never been in that situation.

I'm worried about how I feel about the upcoming November Presidential elections. I'm worried that my feelings about voting might carry over into patient care -- that I'll get so frustrated I decide not to care.

September 24, 2008 in Jeff Wonoprabowo | Permalink


Even though this has been exhaustigly mentioned I won't miss the chance to reiforce that a bandaid can't unite the borders of a exploratory laparotonmy, but many of them can make a difference!
I think we students are too young to lose the hopes and get frustrated. When I say too young, I mean we haven't reached our quota of frustrations yet, before we give up and become one of those middle aged conformists with our future.

As a medicine student I'm hoping whoever wins the election change american's policy from one that curtails human lives to a policy that respect and give value to the human being above all. I hope health care system suffer any modification toward that conception as extension. The rest of the world is, somehow,

I'm not american so obviously I can't vote, but I know that americans' decision at next polls will have effects that will cross US boards. Mainly for developing countries like mine. So please, if your american don't neglect voting. That's a decision for yourself, for other citizens, for other countries and for the future.

For a patient, as well as for the future, I just would not like to check back mentally what was my contribuition to it's destination and regret not doing something I could have done to save it. If I've done everything that was possible, then I'll be able to rest my head on the pillow at night and have the sensation of mission accomplished, no matter what the results were.

Posted by: bandaid | Sep 28, 2008 5:23:15 PM

I completely understand and I am still only in pre-med! I am in the Golden state too, and I hate to admit it mostly because of fear of being ostracized, but I am not a huge fan of Obama and not sure who I will vote for either! I think the best advice I can give you coming from a older non-trad student, stick to your guns and continue to beleive you can and are making a difference, because the truth is you really are even if only planting the seed at first! We can lead by example, but only the individual can truly decide to make a change that will last. So, go be a good example!!!

Godspeed! :)

Posted by: ifeelya! | Sep 30, 2008 6:01:50 PM

I feel for you in this mental anguish, but I must hope that you understand that what Bandaid has said is very important. I am middle aged and thinking about medical school so we are not all conformists. Remember that most of this writing and posting here have so much going for us, it may seem like small things are unimportant, when inreality their are people giving their lives and physical and mental health because they lack the opportunities that we have. If you make a reasoned decision not to vote fine. But patients as an analogy to this is missing one thing person to person contact. Your patient is affected by you as their physician whether or not you see this effecting them. Your help has to see beyond what you have learned in medical school and you must tune in to your humanity. Many people have had difficult lives, and their reactions to their circumstances are not always logical. We can make a difference most of the time. Voting may be worthwhile for you if you look at it from Bandaid's perspective. Taking care of patients, your fellow human beings is always worthwhile. That is humbling to know.

Posted by: Zoe Beale | Sep 30, 2008 6:38:45 PM

I think you bring up a very important sub issue here. There is a problem when doctors have to try to coerce the patients into changing for their own good. I think the problem is mostly psychological or educational. Perhaps the patient simply has not accepted/understood the reality or is not willing to change due to a number of other personal problems/reasons. There are usually problems that Doctors are not even aware of...simply because there is not enough of a chance to have a good relationship with your patient if you only see him/her during rounds. It truly leaves something to be desired (ie time)

However, every problem is just another chance to succeed, another way to find the right answer, and every time that the 20-pack-a-day fellow comes through the door thats just another front to the war that we have decided to fight.

One person can do a lot, but it requires confidence and conviction. No one else will believe in you if you don't believe in yourself. And I believe that wanting to vote is a part of having that belief in yourself. However,if you don't like either candidate... that's a whole different ball game.

Besides a lot of polls are skewed so that people will simply vote for the supposed "popular" candidate. Other times those polls are fabricated just to demoralize the people who have different opinions. It is usually to keep them away from the polls.

Either way it sounds like you have your heart in the right place. There is no better place to start than by genuinely caring.

Posted by: | Sep 30, 2008 8:52:32 PM

All this reminds me of something I saw when I was a kid. I saw a stone cutter who is holding a sharp iron chisel and started pounding it with a hammer in an attempt to split a huge boulder into two. I wondered if this was possible, since those two instruments are quite small and the person himself is not too strong (at least to look at!). I sat there observing. Even after 10 times there is no sign of even a fine crack! But he went on... 20... 30... 50... and 100... But, no encouraging sign! He tried it in different angles. I thought he would give up. But for the next couple of blows the boulder fell apart into two. I was amazed by his persistence.
I feel this is the kind of effort we need to put into to help our patients. When they don't want to follow right then, don't give up. With constant, skillful advice and of course spending ample time to listen to them and address the crux of the issues, I am sure one day they would decide to comply and that day would be our day of victory!

Posted by: Manasa Musunuri | Oct 1, 2008 6:22:01 AM

hmmmm, from your title. i presume you do want to make a difference and just wants some confirmation from the rest. well, they are all there rught here, right now. so there is no reason to hold back anymore,is there?


Posted by: liyang | Oct 1, 2008 6:41:52 PM

I hear you, my friend, and I completely agree that the feeling of "my vote or my decision will not matter, nothing will change" can be really dangerous in certain cases. However, I believe, at some point, deciding for a political situation and for a patient are different even though they seem indifferent.

As a doctor, you can only give advise to the patient, tell him or her what is needed to be done in order for things be ok for him or her. The rest of it is up to the patient. In the end, it's his/her life,health,etc. In this case, you have to respect their decisions.

As a citizen of your country, deciding what is best for your country's and in case of USA for world's future, voting is totally different. To feel that you can make a difference by voting is an important aspect of voting but the most important one is to turn your critisicm of government into something that is valid in politics, in democracy. By voting, you are giving a reaction. If you pull yourself back, if you don't vote, you don't count, you don't get the right to critise anything relating to politics since you did get the chance to show your critism in an area where you're givin the right to make it. You don't vote, but still you'll be ruled by a government which makes the propoganda that it's your voice. Is it? Are you ok with it? Then don't vote. Not voting is equal to not giving advise to the patient. Not giving a reaction is inhuman, considering even the smallest cell gives reaction to it's environment. Not giving reaction means you're not using your citizenship rights. If you're ok with it, fine.

If you ask me however, if you feel your decisions are not enough to change anything in this world, I'd encourage you to scream louder. If voting is not enough, then write to newspapers, join think thanks, use every single opporturnty to express what is right and why it is right. In a way, sending this article, you're doing it but here you're expressing how hopeless and ineffective you feel. Instead, you could have discussed how it would be if people didn't vote, doctors didn't give decisions about what is right for their patients.

If you feel your decisions don't really matter for the patients, instead of throwing the towel, try to find the ways to be effective. I don't know, look through addiction, addictive person's psychology, again and again untill you find a solution.

I agree, at some point, no matter how hard you try, it'll be hopeless. However, in a world that seems hopeless a lot in most of the times, you don't get to be hopeless, if you have even a little hope, even a little desire that world will be a better place tomorrow than yesterday. A single person, a single vote, a single advise may not change anything, but they still have an effect.

Fight, no matter what, fight for your belief, your thoughts. Never let desperation overwhelm you. Give reaction to everything in every condition as long as you consider yourself alive.

Posted by: Melinda Hawk | Oct 1, 2008 11:42:45 PM

If you want to make a difference in these 2 spheres (polital and medical), you need to be involved and be part of revolution. You may think that your vote might not make any difference but you will be surprised if how many other people are thinking like you. If all of you can vote, then I guaratee you a big difference on the poles and your voices will be heard. I'm in South Africa were my former president was forced to resign by his part and most people in the country did not like it. The only way to voice our disapointment will be during the national elections next April. The ruling part (ANC) shall pay.

On the medical sphere, I think councelling you patient is a coner stone for compliance. If you sit down with you patient and explain that if he does not stop alcohol, he wont get a liver transplant and tell him about other complications like acute pancreatitis, Mallory Weis syndrome etc.

Posted by: Sva | Oct 2, 2008 12:39:24 AM

Thank God I'm in the Westminster system

Posted by: Grant Ross | Oct 2, 2008 2:01:03 AM

hi jeff
i ll give u my opnion in both medicine and vote
1st in medicine : if u could not change your patient mind then change your way to deal with them and try if no benefit it does not mean u lose , he know your opinion (medical one) but the patient have his opinion which he found it more suitable for him .
2nd in vote : i live in iraq ,u know about torrisim . but u know it is great to have this prevalge of voting and difficult to give it away for any reason and if the one u choose lose u do what u have to do and give him the sound u think he deserve but others think not so it is opinons. hope u the best.

Posted by: tamara | Oct 3, 2008 2:55:49 PM

hi Jeff
I think tat U must vote i this election as ur vote is verry important.U may be that person who cause McCain or Obama to win in ur state.I am not US citizen, so Idonot know the rules.BUT,Iwant U to know that the next US president ,is not only Ur leader but also will affect the whole world polieces
Ur vote worth alot

Posted by: | Oct 5, 2008 4:44:06 PM

hey, Jeff-- you MUST remember that most people who don't vote think that their vote won't make any difference. That's the sort of thinking that put us in our current economic and diplomatic condition;had those who thought their vote didn't matter....

There's an old story about villagers who were asked to each contribute one cup of ingredients to a communal soup kettle. Each thought their cup wouldn't matter... the result was an empty kettle.

One of my earliest memories is watching my parents vote in the 1948 election. What will your kids remember?

Posted by: witchcatRN | Oct 5, 2008 5:37:54 PM

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