When the Patient is a Racist

Something has changed.

In my first 16 years in practice, I received exactly one insensitive comment from a young child who had never seen an Asian in person. But in the last year, I have received a hateful, bigoted comment approximately every other month. (That includes the remarks by a person who tried to reassure me that the comments were not directed to me personally, but to the “other illegals.”)

My colleagues are experiencing an increase in bigoted comments too. A fellow physician, a southeast Asian man, says he has been called “Dr. Bin Laden” on several occasions recently.

Last September, one of my students was on the receiving end. A patient’s father requested another doctor when he saw the medical student assigned to his son’s case was black. My student and I went to see the patient’s family together. I acknowledged the father’s anxiety and reassured him that we could treat his son. I asked the surgeon-on-call to see the patient.

The surgeon was a Latino with a strong accent. The father said we three — an Asian-American, an African-American, and Latino-American — were not “the type” of doctors he wanted for his son.

I offered to transfer the patient to another hospital.  I never saw that patient again, even though ours was the only in-state facility that could have treated his son’s condition.

At first, I just reflected on the incident on my own: Did I answer appropriately? Did I unintentionally deny a child medical care? What if the situation was life-threatening? What should I have done?

Then I scoured resources about handling bias in hospitals. While most medical institutions have plenty of guidelines on how to address employee-to-employee and employee-to-patient bigotry and harassment, I could not find any concrete guidelines or policies anywhere about managing patient-to-provider bias.

The best I could find was an American Medical Association Opinion on Patient-Physician Relationships. The author recommends “terminating the relationship with a patient who uses derogatory language or acts in a prejudicial manner only if the patient will not modify the conduct. In such cases, the physician should arrange to transfer the patient’s care.”

But transferring care to a partner in the practice does not solve the problem when the providers equally share patients on a rotating schedule.

Ironically, rejecting care on the basis of bias or bigotry only harms that patient further. To protect everyone involved, hospitals must develop zero-tolerance policies — not only between employees but also from customers.

Finally I asked my hospital administrators if I should have handled the incident another way. They told me that other providers within my institution  have also come to them about how to respond to racism from patients.

The volume of these attacks has increased sufficiently that my hospital administrators are actively working to develop policies and curricula to address patient racism directed toward providers. A colleague informally asked other administrators at a medical conference and learned that Mayo Clinic and Massachusetts General Hospital, and medical schools in Indiana, Virginia and Ohio are also working to tackle this problem.

To be sure, a patient may have an acceptable historical reason for initially refusing care based on the physician’s background, such as an elderly Korean patient having experienced Japanese occupation who worries that Japanese provider would genuinely care for him.

But, I argue, bigotry is ultimately not in the patient’s best interest. As in any relationship, people are more willing to help others who reciprocate with kindness. All people try to avoid others who dislike them. Healthcare providers are not immune to these instincts. Anyone would spend less time listening to concerns, answering questions, explaining results and management plans to someone who did not like them.

Limited communication will always lead to decreased outcomes, especially for children, who have the added disadvantage of not being able to advocate for themselves.

We want the best for our children. We want our nation and society to be the best in the world. If the goal is to be the healthiest, the strongest, the most academically and technologically advanced, and to dominate the global market, we should welcome anyone who can help. When we tell anyone that we do not want their skills, talent and effort, we only disadvantage ourselves.

After all, if family members can deride the pediatrician treating their child’s cancer, at whom will they stop?

Julie Kim is a pediatric oncologist with Dartmouth-Hitchcock Medical Center and a Fellow with the Op Ed Project.

Categories: Uncategorized

10 replies »

  1. Without commenting on anything else could you please tell me how the American Medical Association supports racist practitioners and in particular how they allow physician choice?

  2. The author seems unaware that American medicine is two tiered with Whites Only on the first and people of color on the decidedly second tier. Impoverished hospitals in impoverished areas, like Brooklyn and Kansas City, use foreign medical students and cannot attract the best domestic students. Impoverished hospitals are less well equipped and are staffed more or less by rejects from first tier institutions. This is a holdover from racist admissions policies at American medical schools, where a more relaxed standard of care was applied to people of color. NIH famously just let people die of disease so that they could watch them suffering, this was allowed because all the test subjects were African-American. Even today the American Medical Association supports racist practitioners, allowing physician choice as to which patients they will or won’t serve.

  3. The long-standing and well confirmed Principles of collective action verifies that the level of social capital within the users of a common-pool resource is the attribute that most predicts the success of a collective action commitment. Now, I realize that the details of this Paradigm are foreign to the knowledge that supports healthcare.
    Remember now the research study reported last April in an issue of JAMA. It represented a detailed national analysis of the level of poverty, census tract by census tract, and longevity covering 15 years. The study confirmed the relationship between poverty and longevity, but not for all census tracts. The study and one of the 3 editorial commentaries used the term SOCIAL CAPITAL as an explanation of the anomaly. Elinor Ostrom, Nobel Prize 2009, is most widely known for this research.
    Trust as a basis for a caring relationship is very difficult to build when many citizens emerge as an adult after surviving a childhood absorbing Family Traditions dominated by co-dependency and social poverty. The curve necessary to bend that must come from within each community. We only lack the leadership to strengthen the ‘social capital’ asset of each community for the improvement of its Common Good for everyone. The Design Principles for designing a strategy to manage a common-pool resource, a community’s Common Good, have already been defined and evaluated by Professor Ostrom and her many colleagues. We only lack the WILL and INTELLECT to make it happen.

  4. We are seeing it also. I also got a bit of negative feedback from a few of my staff when I hired one of “them”. He has a Middle Eastern name.


  5. “But in the last year, I have received a hateful, bigoted comment approximately every other month.”

    Trumpland, where hate and ignorance are popular again.

  6. As you may have noticed, laws are frequently challenged.

    I am confident that the courts will find that federal hate speech and workplace protections outweigh other obligations. The 30-day notice requirement was written at a time when incidents like this were considered things of the past.

    The Supreme Court will agree.

  7. Dr. Kim I’m sorry for your experience. Unfortunately, It will not be the last time this happens to you.

    John, your response made me chuckle. Of course it’s extremely upsetting for a physician to be treated this way. Unfortunately, it is not legal to discharge a patient immediately when they violate the code of conduct. We must send them a letter by certified mail letting them know of the need to find a new care provider. On top of that, we must allow for 30 days of providing emergency care until the patient can be expected to find an alternative clinician. We have all experienced discrimination based on race, ethnicity, gender, age etc. Of course it’s wrong. In this case, the patient lost out on good care due to bigotry.

  8. A CARING RELATIONSHIP may be defined as a variably asymmetric interaction occurring between two persons who share a ‘beneficent’ intent over time to enhance each other’s ‘autonomy’ by communicating with warmth, non-critical acceptance, honesty and warmth. With conditions of limited resources, the options are grim. With conditions of unlimited resources, the options are simpler. I suppose the first step is to make reasonably certain that Emergent diagnosis is not possibly involved. This all becomes even more problematic when the person needing health care is a dependent person.
    The disintegration of ‘Community’ and its ‘social capital’ of trust seems to be at the root of so many issues these days. It does not bode well as our nation’s annual Federal Deficit careens out of control.

  9. This pisses me off.

    The answer is simple.

    A notice should be placed in a prominent place in the physician’s office.

    “This practice/facility does not treat those who violate our patient code of conduct.”

    Patients who violate the rules of common decency should be denied treatment and asked to take their business elsewhere, just as they would in any other business.

    If you prefer, an additional facility charge could be applied. I doubt insurers would cover it.