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.