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Medicine’s Changing View Of Racism Towards Healthcare Professionals

Almost a decade ago, I was subject to a racist tirade by a patient.

The patient told me, “Why don’t you go back to India?”  

I responded angrily to the patient: “Why don’t you leave this [expletive] hospital?” 

I sought guidance on how to cope with and respond to the patient’s racism and found little.  The institution at which I worked had no policies in place that guided my response.

I had the patient’s care reassigned to other physicians and subsequently wrote about my experience and reflections in an essay called, “The Racist Patient,” that was published in the Annals of Internal Medicine and featured in the New York Times.

My conclusion: there were limits to service and the abuse to which we might accept as healthcare professionals.

The essay generated controversy and drew two different kinds of responses.

The first set of responses was from sympathetic physicians with like experiences who felt unprotected by the institutional cultures in which they worked.  

I heard from an African American physician whose hospital routinely reassigned patients from his care so as to not compromise their patient satisfaction results.

I heard also from a pharmacist whose management accommodated a patient request to not have “that Paki touching [their] meds or speaking to [her] about them so make sure the other pharmacist is available.”  

One Vietnamese-American academic physician wrote:

“I am of Vietnamese-descent and your article had a resounding impact on me.  I have experienced such overt racist and sexist comments in my career made so much more difficult when it is directed at me as an attending physician and in front of my residents.”

The second, more dominant set of responses was from physicians who held the view that healthcare professionals are somehow held to a higher ethical standard, that the unwritten code of professionalism requires us to ignore our own feelings and continue to care for patients regardless of their views.

One physician wrote an extensive letter to me in response:

“The tone and words in your article demonstrate to me that you have a long way to travel, not to India or anywhere else, but to a place in your heart that tells you that being a good doctor means that patients, even difficult patients, deserve better treatment than that which you gave to [the patient]….But upon further reflection you arrogantly felt justified in not apologizing to him because ‘there are clear limits’ to your service. Yes, doctors are not slaves, submitting to any kind of abuse but your….response was not professional.”

Another physician wrote a published letter to the Annals of Internal:

“His complaint was legitimate…You missed an opportunity to heal and win over a fellow man.”

I certainly regretted my angry instinctual initial response—but also felt that the traditional institutional perspective on abusive, racist patients is medicine’s own version of “the customer is always right.” Being a medical