Everything Is Policy

Seamus Vahey, MS3
Boston University Chobanian and Avidesian School of Medicine
EMRA MSC Legislative Coordinator

Sitting behind the row of residents and attendings dictating notes, diligently whispering into the recorders in their closed fists as words crawled across their screens, I did my best to stay out of the way. As I sat there waiting for instruction, my heart raced at the thought of potentially seeing an emergent chest tube being placed or being asked to do CPR as I had seen on so many of the medical dramas I watched on TV.

The attending turned to me and said “how about we go see this patient who is coming in with back pain, I think she is sitting in the chair over there in the hall. Oh, and she speaks Haitian Creole if you don’t mind calling up the translator on your phone.” As I walked down the hall of the bustling ED, flashcards and frameworks flashed before my eyes trying to generate a differential for her pain.

As I approached, I saw a frail older woman sitting dignified in a basic armchair, watching the world whirl around her. I connected to the translator and asked what brought her in. Calmly, she described how she had recently moved to the United States from Haiti, and had a painful rash break out on her back last week. After asking a few more questions to rule out any acute changes that may have led her to come to the ED that day, we visualized a textbook shingles rash. Her treatment would be straightforward. I walked away with an initial sense of disappointment that I would not be involved in the dramatized heroics as I hoped. On further reflection, however, I came to appreciate how she represented a manifestation of the policies that impact the world around us.

As students we are often hyper-focused on the pathophysiology of disease. We spend four years learning illness scripts, differentials, and mechanisms of disease, but really everything is policy, it influences the world around us at all levels. The exact pathophysiology of her rash may have little importance if the patient we saw was not able to meet her necessities of food and shelter like many Haitian migrants in the city.¹ Would the hospital policy allow her son to come and visit her while she waited for improvement in the hospital?² Would state insurance cover medications she needed to limit her illness progression?³ How had national policies on immigration exacerbated her illness?⁴ And what impact had international policy had on her home country that drove her to seek a life here?⁵

In a time when evidence-based practices in medicine like harm reduction⁶ and abortion,⁷ access is being limited by policy. Our work matters more than ever. I hope medical school is a call to action for students to get involved in policy at any level. Patients like the woman I encountered are the constant motivator for me to be involved in this work. Whether in the hospital, local community, state, or national level, there are endless ways to get involved in policy work. Writing op-eds, doing research, and sitting on committees are a great place to start. You can also testify in public hearings at local legislative sessions, call or email representatives. While they may not show it on the TV dramas, everything in medicine is really policy.

References

1. Hager C. Boston Medical Center inundated with migrants from Haiti. May 1, 2023. Accessed November 20, 2025. https://www.cbsnews.com/boston/news/dozens-of-haitian-migrants-flood-boston-medical-center/
2. Nuss T, Kelly KM, Campbell KR, et al. The impact of opening visitation access on patient and family experience. J Nurs Adm. 2014;44(7/8):403-410.
3. Pillai A, Pillai D, Artiga S. State Health Coverage for Immigrants and Implications for Health Coverage and Care. KFF. May 29, 2025. Accessed November 20, 2025. https://www.kff.org/racial-equity-and-health-policy/state-health-coverage-for-immigrants-and-implications-for-health-coverage-and-care/
4. Jacobs JW, Bibb LA, Gutierrez JR, et al. Immigration enforcement tactics and systemic health harms: The ethical imperative for medical advocacy. Ann Intern Med. 2025;(ANNALS-25-03151). doi:10.7326/ANNALS-25-03151
5. Jean MC. The parallel state: Neoliberalism in Haiti and the reliance on NGOs. Int NGO J. 2023;18(1):1-9.
6. Kleinschmidt A. Published online July 29, 2025. https://www.samhsa.gov/sites/default/files/dear-colleague-letter-executive-order-ending-crime-disorder-americas-streets-07302025.pdf
7. Hill L, Artiga S, Ranji U, Gomez I, Ndugga N. What are the Implications of the Dobbs Ruling for Racial Disparities? KFF. April 24, 2024. Accessed November 20, 2025. https://www.kff.org/womens-health-policy/what-are-the-implications-of-the-dobbs-ruling-for-racial-disparities/