A cornerstone of clinical excellence is treating all patients with respect and dignity. This is true even when treating those patients who are not respectful to you.
Working with patients who exhibit racist behaviors is challenging. A few weeks ago, I was taking care of an 86-year-old woman in the hospital. Mrs. T had a history of depression, delusional disorder, schizotypal personality disorder, and diverticulitis with subsequent sigmoid resection and was admitted with cellulitis and tachycardia.
When I first met her, I politely introduced myself as her attending physician along with the physician assistant who was working with me. During the course of examination, Mrs. T mentioned that all her trouble started when her bowels were taken out. She had requested that they be placed back. She mentioned that she’d written letters to the president of the hospital and to the president of United States with her request. During the 30 minutes that we spent together, she wouldn’t look at me and directed all her conversation towards the physician assistant.
As her tachycardia persisted, I reviewed the differential diagnoses and was concerned that she might have pulmonary embolism. I discussed my concerns with her and explained that we needed further imaging. She refused any imaging and insisted that everything would be all right if we put her bowels back. Mrs. T was also evaluated by psychiatry who determined that she had capacity to make decisions. We finally consulted with ethics, who agreed that the patient needed further testing to evaluate for pulmonary embolism.
My duty was to care for my patient
All this while, Mrs. T never looked at me while talking, and sometimes would address me as her nurse or tech. It had also been noted that she’d sometimes been rude to her nurses and support staff who weren’t Caucasian. She wasn’t rude or abusive towards me, but wouldn’t acknowledge my presence in the room. Mrs. T mentioned a few times that, “Trump is the best president the country has ever had and Obama is an immigrant who lied about his nationality.” It was difficult to ignore her comments, but my duty was to care for my patient who was extremely ill and needed my help.
The ethical dilemma
There’s an ethical dilemma when a patient refuses care by a clinician based on the clinician’s religion, ethnicity, color, or gender. It’s the duty of the physician to provide care, not to treat patients against their wishes, and to do no harm. Some articles mention that re-assignment of patients to another clinician can sometimes be facilitated, but it isn’t always easy as it increases the workload for the other physician. This also isn’t ethical, as it conveys to the patient that it’s acceptable to make these demands and exhibit such behavior. An NEJM article, “Dealing With Racist Patients,” says, “This type of behavior shouldn’t happen, and if it does, it certainly should not be accommodated.” Additionally, employees of healthcare institutions have the right to a workplace free from discrimination based on race, color, religion, sex, and national origin, according to Title VII of the 1964 Civil Rights Act. Unfortunately, I anticipate that these incidents will only increase due to the current political climate in the United States and the increasing diversity of the population.
The need for training
I wasn’t trained to react to the hostility I faced; I chose to ignore it and performed my duty to my patient. There’s a need for organizational policy and guidelines, but more importantly healthcare professionals need to be trained on how to face and respond to these situations.
What I’ve found helpful when dealing with patients who exhibit racist behaviors:
1. Remind yourself that your duty is to help your patient.
2. See your patient together with PA/NP, nurse, and/or resident team.
3. Tell the patient when their words and/or actions are rude towards the care team.
4. If the patient’s racist behaviors affect your ability to give care, ask a colleague if they could take care of the patient.