When racism takes over healthcare
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On May 27, two courageous men in Portland, Ore., were stabbed to death, and a third man seriously wounded on a train after confronting a man for yelling slurs at a Muslim woman and her friend. These men were heroic and compassionate in how they responded to the cruel assailant. This stabbing raises questions about how ordinary citizens ought to respond when racism arises in public spaces. One particularly complicated issue is when racism manifests in a healthcare setting.

Late one night in my call room, I was lying in bed, sleeplessly staring at the ceiling, waiting for my pager to rattle me to attention. As a physician in psychiatry, the uncertain anticipation breeds a tension that renders restful sleep virtually impossible.

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Finally the call came. The nurse told me that a patient was being loud, belligerent and disruptive, and I should come to assess her. When I arrived, I looked over the unit’s common area and quickly realized who the nurse was referring to: a petite, elderly Caucasian woman was yelling obscenities to the staff. I carefully slinked behind her near the nurse’s station and said, “Excuse me ma’am.” She turned around, took one look at me, and said, “I don’t want no n----r doctor.”

 

My heart sank. The other patients and staff froze, fixed on the evening’s spectacle.

"Get that n----r away from me!” she yelled. Her remarks became like theatre for the other patients and staff as they waited to see my response.

I did not let the patient’s hate deter me from trying to be a compassionate caregiver. I attempted to re-address her, “Ma’am, I’m Dr. Williams, how can I help you?” The patient did not speak to me directly nor did she make eye contact. To her, I do not even exist. I am not human. I am just a n----r.

How do I begin to be a benevolent provider when the patient does not even acknowledge my humanity? Physicians have little guidance, if at all, on these situations involving explicit racism and bigotry from patients.

Recent efforts to address and deal with the “racist patient” have gained momentum recently especially given the current social and political climate. Many patients have found their racist sentiments emboldened and validated by the changes in U.S. presidential administration and growing nationalist movement. 

These cases raise several complex, and confounding questions: How should the medical team, the other patients in the waiting room, and the rest of the staff (from the janitors in the hallway to the clerks at the front desk) respond to racism? What policies help staff to decide how to respond? 

Currently, there is no specific policy for dealing with the explicitly racist patient who refuses care from a minority physician. There have been efforts recently from legal and medical scholars to cite specific laws to help steer the approach to these difficult situations.

The Emergency Medical Treatment and Active Labor Act (EMTALA) dictate the physician must initially assess how sick the patient is or if the patient is in the state of life-threatening illness. If so, the physician's obligation to preserve life overrides any ethical dilemmas he or she may have toward the belligerent patient. 

If the patient is not life-threateningly ill, the patient has the right to refuse care from any physician, as commanded by the centuries-old ethical principle of patient autonomy. Moreover, scholars have cited the Civil Rights Act of 1964 to assert that the physician, as a hospital employee, has the right to work in a non-hostile, non-racially discriminatory environment; thus, the physician is not obligated to treat this patient. Is the hospital legally or ethically obligated to accommodate the patient’s request for a non-black physician?

If the patient is thought to be medically and psychiatrically stable, and the patient continues to be racist and combative, thought must be given to where these attitudes are derived from.

For instance, I once took care of a Vietnam War veteran whose post-traumatic stress disorder was triggered by seeing Asian-appearing faces, which reminded him of the enemy soldiers during the war. He persistently refused to receive care from Asian-American doctors. In this case, his racially discriminatory beliefs are based primarily in his psychiatric illness. Therefore, it may be necessary to make certain accommodations given that his racist beliefs are inherently tied to his disease.

If the racist beliefs and subsequent refusal of care from a minority physician is thought to emanate not from psychiatric disease but from the patient's own pre-existing belief system, then a separate ethical dilemma becomes apparent. Many scholars have argued that a release of services or discharge from the hospital might be an appropriate end.

The recognition of racially hostile behavior without direct resistance is to corroborate in the propagation of the inexcusable racist attitudes. Some have argued that failing to directly address the offense behavior is morally reprehensible, disrupts the healing environment for the other patients and must be expelled.

Aside from the legal and ethical principles, physicians and staff should be encouraged to come together as a community to heal after these ostensible verbal assaults. Maintaining a status quo culture of passive acceptance allows for racist attitudes and behavior to continue and does not acknowledge the pain or stress felt by the physician or staff members.

Incidents of racism and bigotry are a problem for everyone when they occur in public spaces. Citizens who occupy the space, whether it been patients and staff in a hospital or people riding a train, need to decide on what kind of community they want to be apart of and proactively rally together to carry out that vision.

J. Corey Williams M.D. is a resident physician at Yale University Department of Psychiatry. He mentors inner city youth and is interested in ethnographic research in disruptive behavior disorders in children. 


The views expressed by contributors are their own and are not the views of The Hill.

—This report was updated on June 13 at 7:50 a.m.