Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

How to Create Sanctuaries for Patients


To create safe spaces for historically marginalized patients, slow down and gather more information when conflicts arise. Be aware of your biases and give patients the benefit of the doubt.

In a recent perspective piece for the NEJM, “Without Sanctuary,” I wrote about a painful memory—a mistake I made as a resident that continues to haunt me. In the piece I recall an experience in which I failed to intervene to protect my Black patient from police violence—something that’s unfortunately more common for Black people in the United States and especially disturbing in the hospital setting.


I wrote this piece to acknowledge the ways in which, I, a Black physician, have been complicit in the dismantling of safe spaces for my Black patients. But more importantly, I wrote this piece to reflect on my ongoing journey to seek atonement for that harm, practice antiracism in medicine, and to invite others to do the same. With regard to healthcare and criminal justice system interactions, and more specifically, our role as clinicians when having to make the call to involve law enforcement in our patients’ lives, I offer three recommendations:


1. Slow down.

Whenever possible, especially when working with BIPOC patients—slow down.  Slow down and gather more information, think about if there are other ways to handle the situation without calling security or law enforcement, and consider if an alternative messenger would help—this is also where an ethics consult may be helpful.


2. Extend grace indiscriminately.

Who we do and do not extend grace is a learned habit. These habits become our biases. We must unlearn them. This requires awareness, intentionality, and practice. You must ask yourself, “What does it look like if I extend grace and the benefit of the doubt to this person?”

In situations of stress or fatigue, we use mental shortcuts and biases may arise quickly. We must be aware of this and work to combat it.


3. Understand and question policies related to policing in your workplace.

Ask the questions—what are our policies around handcuffing? Police parole on the property? Police presence during physical exams? Safety is key, but asking, “Is the presence of the police and their interactions with patients in this scenario aligned with the best interest of the patient?”



This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.