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Monday Aug 21, 2017

How Do I Deal With a Racist Patient?

Emergency room physician and Oregon Health & Science University faculty member Esther Choo, M.D., M.P.H., recently made headlines and created a significant social media buzz when she tweeted a moving thread about patients who refuse her services because of her race(twitter.com).  

[Black and white hands reaching for each other]

In her 10-tweet thread, which has been retweeted more than 2,400 times and liked more than 48,000 times, Choo questioned how patients can be "so wedded to your theory of white superiority that you will bet your life on it, even in the face of clear evidence to the contrary." She said her response is to show compassion.

"I figure the best thing I can do is make sure their hate finds no purchase here," she tweeted.

We asked some of our new physician bloggers if racism has affected them in practice and how they deal with such encounters. Here are their responses.

Lalita Abhyankar, M.D., M.H.S., New York, N.Y.

Recently, I had a conversation with my former co-residents about caring for prejudiced patients. During residency, one of my classmates had taken care of a man who was a Jewish Nazi sympathizer. Another classmate talked about a patient -- a "curmudgeon of a man" -- whose racism seemed, prior to recent events, to be benign and of a bygone era. My own experiences with racism were subtle, like the patient who asked how often I went home to "my country." (I was born and raised in the United States.)

However, the story that struck me most was a co-resident's experience of building a patient-physician relationship with an elderly anti-Semitic man. The patient chose my Asian classmate as his physician because, based on the patient's logic, an Asian man couldn't be Jewish. My classmate, whose wife is Jewish, provided care to the best of his ability and continued to see the patient frequently throughout residency.

Patients' rights allow them to choose their physicians based on gender, experience, and/or comfort. But patients' rights also mean that they can select physicians for bigoted reasons. In an outpatient setting, if we believe a patient's views could compromise our ability to provide good care, we can, and should, request that the patient see another doctor. However, if faced with a bigoted patient, we need to remember that, like Esther Choo, we should try to avoid the cycle of "disbelief, shame, anger, … show compassion, and move on."

Helen Gray, M.D., Kirkland, Wash.

"I really don't like Western medicine and much prefer the medicine of your people," a patient told me during my second year of practice.

I remember talking about this with my colleagues, all of whom were white, and they thought this comment was funny. Although the patient was attempting to compliment my Asian heritage and was excited for me to care for her, I couldn't help but feel like I had been given a back-handed slap with that compliment.

I'm proud of my Asian background and recall receiving many treatments as a child that weren't evidence-based and aren't used in my practice today. However, the assumption that I was going to treat them differently or offer different advice because I'm Asian was slightly frustrating and insulting.

Since then, I've had patients leave my practice because they felt I was too young and couldn't understand their needs, or because I was female and they wanted a male physician. I choose not to dwell, I choose not to be offended, I choose to rise above people's unfounded perceptions of how I'm able to care for them based on my external characteristics rather than my merit. I fight back against discrimination by loving and caring for my patients regardless of their race, age and gender and hope that they will one day treat others the same way.

Marie Ramas, M.D., Nashua, N.H.

"There is no longer Jew nor Gentile, neither slave nor free, nor is there male and female, for you are all one in Christ Jesus."
-- Galatians 3:28

There were times in my training that I had to remind myself daily of this basic biblical teaching because the South presented challenging situations based on race. I recall my first blatant encounter during my intern year when I cared for a toddler girl who had a severe asthma attack that required an overnight stay. She was morbidly obese, and her parents were chain smokers. While rounding on the child one morning, the child's father paced the room during my evaluation. His T-shirt, which bore the confederate flag, was torn and weathered. He puffed his chest as he questioned my clinical judgement and treatment plan. He obviously was uncomfortable in my presence. Meanwhile, his daughter was able to breath comfortably in her bed because of the care I had provided.

The irony of being a black physician in the face of racism is reflected by the reversal in roles of power. The oath I made as a healer is irrespective of color or creed. At the end of the day, all blood runs red, all people suffer and all people will need to defend their actions and philosophies at some point.

Do racism and hatred in the sphere of medicine surprise me? Not at all. We are humans taking care of equally damaged humans. However, I would be remiss if I omitted the disappointment I feel about how our society responds to philosophical perspectives that endorse hatred.

Venis Wilder, M.D., New York, N.Y.

I have not encountered overt racism in my career as a physician. However, I have encountered countless small slights from patients who are not accustomed to a young female physician of color. This has included subtle slights from people of all races, including my own. Unfortunately, systematic racism is powerful like that.

In the office and hospital settings, I have repeatedly encountered raised eyebrows, strained "good for you" comments and coldness that have all added up to a difficult-to-combat, insidious prejudice. It is hard to openly confront these microaggressions because, as the doctor, I could appear combative or confrontational for something seemingly ambivalent but packed with inference. A raised eyebrow suggests there is surprise or a question about my ability. A "good for you" is an unexpected affirmation of my credentials as a physician, as if it were impossible for a black woman to achieve this level of training. And coldness often replaces blatant verbal disrespect because the other is just too obvious.

All of this presents a power struggle that has already been inserted into the room before the true medical interaction begins. It is an unnecessary energy that does not serve the patient or their well-being, and it continues to poison the people of America, preventing us from reaching our highest level of health. It's time to openly address this illness of racism and find a cure for its total eradication. It is literally killing us as we wait.  

Posted at 05:58PM Aug 21, 2017 by Lalita Abhyankar, M.D., M.H.S.

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