Confronting the bigoted patient

Avatar

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.

Related Post Roulette

57 Responses

  1. Avatar Kazzy says:

    Yikes. What a complicated issue. I have a few different thoughts milling about…

    1.) If I’m searching for a provider via my health insurer’s website, they offer a good amount of demographic information, including gender, language(s) spoken, and alma maters. Fair or not, if the profile indicates that English is not the doctor’s first or primary language, I often keep looking. I consider the ability to communicate clearly with a doctor very important, and after at least one situation where a doctor had insufficient English language skills leading to some real confusion, I tend to be a bit more selective. Additionally, I typically give favor to doctors with training and education in the States. I, generally, know the standards here and don’t know them for other countries. I’d be curious to hear your thoughts on either of these admitted biases. I should also note that if I receive a referral from a doctor I trust to a doctor who turns out to speak English as a non-native language and/or who studied outside of the country, the referral trumps all that.
    2.) I sympathize with the distinction you draw between people in traditionally marginalized groups versus those from traditionally privileged groups. However, it does require at least certain assumptions being made about intent, which always gets tricky.
    3.) At my first job, an issue arose after I helped a female student with toileting. The girl had finished going and requested my help with wiping. This isn’t something I normally did for logistical reasons unrelated to gender but I was the most accessible teacher at the moment and thought it better to ensure her needs were met than anything else. So I helped her wipe. Apparently, insufficiently. When she got home with some staining in her underwear, her mother asked about it and the girl relayed that Mr. Kazzy had helped her. From there, mom approached the director to express her discomfort with the situation. I wasn’t privy to the conversation, but mom was apparently very understanding and respectful, noting the difficulty in voicing her concern but ultimately saying that she would rather I not help her daughter in the bathroom going forward. As a bit of context, mom was Muslim, though was fairly moderate, and she apparently had a rocky divorce from the girl’s father. So, there were a lot of angles from which she could have come at being uncomfortable with her daughter being attended to in the bathroom by a male. Mom also apparently made it clear that she meant nothing personal to me and otherwise loved my work with her daughter; the idea of a man helping a young girl in the bathroom just didn’t sit right.
    As I was the center’s first male employee in a number of years, my boss wasn’t really prepared for this situation. Over several conversations, she decided to acquiesce the mom’s request, initially asking that I not help that particular child before ultimately deciding I shouldn’t help any child in the bathroom. When initially confronted with the situation, I was compliant. I was 21 and this all sort of happened fast. But as it evolved, I was increasingly bothered by it. Not only were their logistical issues (this would basically require me having a female teacher at my side at all times), but the gender issues were apparent. A colleague, a black woman, asked the director if she would accept a parent’s request that she not do something because of her race. I ended up leaving the center for unrelated reasons before the situation was formally settled (this all happened over a matter of a couple of weeks). But, yea, it was complicated. My sister, a lawyer, said the director acted prudently to minimize risk (I’d be curious to hear Tod’s take). But I couldn’t help but think my boss was putting in place different rules for the different genders. And doing so only contributed to the suspicion levied against men in childcare, creating a perverse feedback loop.

    ANYWAY, yea, I get where you are coming from on the difficulty of the topic. Ideally, it would be one we didn’t have to deal with. But we do. As such, the goal should be to resist racism, sexism, homophobia, and other forms of hatred in all its form. If you can reasonably ascertain that a request is motivated by any such thing (which would include requests framed as such by people of the aforementioned traditionally marginalized groups), it should be rejected.Report

    • 1) I can certainly understand your reasons for seeking a native English speaker and one trained in the states. They have nothing to do with the innate characteristics of the provider, but with either the proficiency by which they could convey complicated concepts or with your perceptions re: the standards for their education. That does not strike me as morally problematic or objectionable. If you were unwilling to see a person trained in Japan for whom Japanese was a first language but who was the head of pediatric neurosurgery at the major hospital near you because of his being Japanese, that would be a different story.

      2) Dealing with this kind of question is always a judgment call, which always involves some risk of error. The above is just my baseline approach.

      3) I remember your writing about the subject when it happened. I think it’s very, very tough. As for the initial concern on the part of the mother, it seems clear she was trying to be careful and respectful. The blanket ban on your helping with all toileting was excessive.Report

  2. Avatar Jaybird says:

    I’m reminded of the Sanford and Son episode “Tooth or Consequences” when Fred Sanford demanded to see a white dentist. It was funnier than what’s depicted here.

    I admit to understanding, a little, making some minor requests regarding, say, gender. A female asking for a female doctor is something that I would see as a perfectly normal request and (I imagine) if I were a doctor, such a request would be perfectly understandable if I got one and I’d either figure out if there were someone suitable to treat the patient and, if there weren’t, I’d wince and explain that there wasn’t (with much more of a “is that okay?” undercurrent than a “beggars can’t be choosers” undercurrent).

    And, I mean, if the person happened to be a Muslim woman of a certain age who made the request? I mean, I’d be surprised if I weren’t asked that. I imagine.

    Am I coming at that wrong?Report

    • I am generally more sympathetic to a female patient wanting a female doctor, certainly for gynecological care. I have a lot of teenage male patients who used to see my female colleagues but, at the approach of adolescence, wanted a guy. The gender preference seems less likely to be motivated by prejudice, though I would say something different if we were talking about neurosurgeons or cardiologists.Report

      • Avatar J_A in reply to Russell Saunders says:

        AS it happens, I had a female primary physician for many years (and I am a guy). As years went by (I just turn 50), and my primary care involved more and more concerns about my prostate, my T-levels, my ability to raise the pole (why is it better in the mornings that the evenings and what not)etc., I finally switched to a male primary doctor last year. Silly as it is, I really couldn’t face discussing my prostate or my sexual life with her.Report

      • I would probably prefer a male primary care provider. Under my old insurance, my primary care provider was a woman nurse practitioner. She was quite competent and easy to talk to, but still, on a certain issue that came up at one point, I found it hard to talk to her because of my self-consciousness. I *think* I might have been less self-conscious with a male, all other things being equal.

        But I agree with Russell. If I were, say, having my gallbladder removed, I wouldn’t care about the gender of the surgeon.Report

  3. Avatar DRS says:

    Are you sure you’re not conflating two separate things here? There are bigots and then there are people who are frightened and want the reassurance of the familiar, even if they phrase things badly and come across as insensitive.

    In Ottawa a number of years ago, the provincial government wanted to close or merge with another facility, the only French-language hospital outside of Quebec. All enfer broke loose. John Robson, the most conservative journalist-pundit in the region ran a column that started out “When you’re sick, old or dying is not time to brush up on your English-language skills” and went on to say that patients needed a healthy attitude to get better and if that meant dealing with medical staff in their own language then that was a valid enough reason for resisting the closure. Now, Robson was not a squishy leftie and from a media perspective when he weighed in on the issue that pretty much settled the matter as far as the locals were concerned. (It took a while but the hospital did not close, retained its autonomy and is still doing good work, as far as I know.)

    But if mental and emotional well-being are integral to good health, then I think people can make allowances for a patient’s desire to see a familiar face or hear a familiar voice. Even if the request is made in a manner that is hurtful: personally I think that I would take it as the illness talking and not the patient.Report

    • Avatar Kazzy in reply to DRS says:

      FWIW, I thought Russell made clear just such a distinction, albeit not as clearly as you did here.

      I wouldn’t find it objectionable for a white male patient to say he’d rather discuss testicular cancer with a male doctor because, well, he’s used to talking about his balls with guys and he presumes the male doctor would empathize with the situation differently than a female.

      But if his logic was that female doctors were bad at math and science because of all those dang fallopian tubes… eh… suck it up, doofus.Report

      • Avatar DRS in reply to Kazzy says:

        I found Russell’s narrative less than clear – which surprised me, because he’s usually a rather fluid writer. Also the image on the main page of a heavily-tattooed arm giving a Nazi salute, in my opinion, rather stacks the deck about anyone who might make demands about the kind of medical personnel they’d like to have in attendance. Out-and-out racists are more the exception than the rule and I’m not considering them in my response. But starting out the article with that kind of an example and then going on to people whose responses and requests I would categorize more as unfortunate and biased, strikes me as being unfair. Especially since a medical situation is one where people will talk and act in ways that they probably wouldn’t in a non-stressful situation. I don’t get the feeling from Russell’s descriptions that he takes into account the emotional stress patients might be under even in a routine healthcare environment.

        I have dealt with doctors and specialists – especially specialists – who ignored my questions, talked over my answers, made personal comments – not favourable ones – about my age and gender. So I’m not perhaps as quick to empathize with the medical professionals as others might be.Report

      • You know, the more I think about it the more I think the image on the main page is unhelpful. I chose it because the article in the Times starts with an anecdote about caring for a man with a similar tattoo, but the picture probably doesn’t add to the narrative absent my referencing that anecdote in my own post. I think I will change it based on this feedback.

        And the point I was trying to make (inexpertly, it would seem) is that I do think actual racist requests in the medical environment are quite rare and even more rarely accommodated, which is not what you’d get from the Times piece, which conflates being culturally sensitive with knuckling under to prejudiced patients.Report

      • Avatar Shazbot3 in reply to Kazzy says:

        “Out-and-out racists are more the exception than the rule.”

        I disagree, especially since we are also talking about not just racism, but also sexism, homophobia, and religious bigotry. (And I suspect when people’s health is at stake, the bigotry comes out more.) In total there is a lot of bigotry, and to accede to it all would be bad for the medical community, which would in turn would make it harder for the medical community to do their job, which in turn would be bad for the whole community.

        Maybe 75% of people wouldn’t be sexist, racist, homophobic, Islamaphobic, anti-semitic, etc. in choosing doctors, but even 25% (or 10% or 5%) would make it harder for minority doctors to practice and hospitals to operate, which makes the hospital’s mission harder, which means it is and should be a no-go for the health care community.

        I think the Doctor was clear that some requests for doctors of a certain gender (or maybe race or religion in some cases) could be acceded to fairly.Report

      • Avatar Kazzy in reply to Kazzy says:

        Shaz,

        While I don’t doubt that hate exists is great number, the number of people who will vocalize it, publicly, with their name attached, is rare. Or rare than the total amount of hate. It is one thing to troll the inter web with hateful nonsense. It is another to sit there in a doctor’s office and say, “Yea, about Dr. Martinez… no spics please.” Folks may attempt to get at it slightly more artfully than that, but they’re more likely to grin and bear it and then bitch about the dirty immigrant once back at home. Homophobia is still more widely accepted, so I imagine it might surface more often, but it is also not necessarily evident who is gay as it is with who is male/female or who is black/white/Hispanic/Asian/etc.Report

    • Avatar Russell Saunders in reply to DRS says:

      Perhaps I did not express this well in the OP, but I think the two issues are actually quite separate. Indeed, I think the Times article conflates them and I am trying to highlight the difference.

      If I were still in a position where I was assigning patients to residents, I would obviously try to pair them if there would be some benefit to the patient from a cultural affinity. But certain lines must be drawn, and judgment must be made about to what degree a patient’s “comfort” is a nicer way of saying “bias.” No doubt it was quite uncomfortable indeed for a great many people to greet women and black people and all manner of other previously-undesirable elements presuming to treat them in clinics and hospitals, but their discomfort was something that they needed to get past, not something to be accommodated.Report

      • Avatar DRS in reply to Russell Saunders says:

        I think you’re making a lot of assumptions in this comment about what people really think or feel.Report

      • Well, at a certain point judgement calls have to be made. No single approach to any sensitive issue is going to obviate the need for appreciating nuance from time to time.

        But treating the patient’s comfort with familiarity as a primary value can very easily lead to medical providers from minority cultures and races being excluded from patient care, and can reinforce prejudice against them.Report

      • BTW, I do concede that an unspoken part of my narrative relies on an assumption that my judgement is generally sound and trusting that I made a good call in the case I describe above.Report

      • Avatar DRS in reply to Russell Saunders says:

        Actually, Russell, the examples I’m familiar with in Toronto are patients asking for minority and women medical staff, not rejecting them. For the record, I have worked in two hospitals, not as a medical professional. Toronto hospitals go to great lengths to make sure that the hospital staff “reflects the diversity of the community” so that patients originally from Southeast Asia can have a Vietnamese-speaking nurse or doctor in attendance while they’re having an angina attack.

        You wouldn’t make a diagnosis about a chest pain without a physical examination with tests so I’m not sure that coming to a firm conclusion about personal views without more exploration is warranted.Report

      • It seems that asking for a physician who speaks the language in which you’re most comfortable communicating is different from asking for a physician who’s the same race or gender than you. Which is not to say that racial and gender requests can’t be perfectly valid and morally unproblematic. I’ve made gender requests in a a few different medical situations (they were honored in all cases), and I don’t feel bad about it at all. And were I an ethnic minority, particularly one with a history of discrimination, I can imagine I might want a doctor in whose objectivity, and recognition of my humanity, I’d be more confident. It might be an unnecessary precaution, but when it comes to my health, I’d rather air on the side of caution.Report

      • Avatar Kazzy in reply to Russell Saunders says:

        DRS,

        One of the things about hate is that people who harbor it often assume it on behalf of others they presume to be like them. So, the way a white person will look over both this shoulders to check for black folks in the room for telling a joke that has the N-word as a punchline but won’t say, “Hey, fellow white people, none of y’all are anti-racists, are you?”… sometimes people will let their true colors seep out in more obvious ways.

        They might not say it outright, but they’ll give enough inference that one can reasonably assess motivations.

        Conversely, if someone is dealing with someone not like them, they’re more likely to be explicit in their request, because they do not assume understanding.

        For instance, in my school, many parents of color complain about the complete lack of diversity among the faculty. But they make clear their intent: “My child doesn’t see anyone who looks like her on the faculty.” “The only black people my son sees is the dishwasher in the kitchen. Where are his role models.” Now, maybe that is all a cover for anti-white bias but, well, they picked a weird place to send their kid if such is the case.
        On the other hand, I’ve had some white parents say things in passing like, “Ya know, I liked the way we recruited kids back when I was a student. We didn’t send busses up to… [whispers] Newburgh.” “Hey… these doll house figures aren’t very diverse. You don’t have a short pudgy white guy with glasses. My kid doesn’t see someone like her father with these [wink wink, nudge nudge].” Do those people come out and say, “We like it better when everyone is white and we don’t have to deal with all that diversity nonsense?” Of course not. But they see me, a white guy, and assume they’re safe. Somehow they ignore the part of my email signature that says “Director of Diversity” and have to content themselves with me ignoring them or saying something snarky.

        All this to say that white men (like Russell and myself) might be “privileged” to slightly more honest intonations of intent from other white men about race or gender because they see us as one of their own.Report

      • Kazzy, a couple years ago, my girlfriend and I went to see The Guard with Brendan Gleeson and Don Cheadle. There’s a scene in the film in which Cheadle’s character is giving a briefing about some nasty drug dealers, with Gleeson in the audience. Cheadle puts up a photo of the drug dealers, who are all white dudes, and Gleeson says, “I thought only black lads were drug dealers.” It’s really funny in the moment, but she was the only black person in the theater (it was a little art house theater on a week night; there might have been a total of 12 people in there, counting us), so before laughing, everyone turned to look at her to make sure she was laughing. Then they laughed. It was a really weird experience for me, but we talked about afterwards and she said that sort of thing happened pretty regularly. I must say that it made me laugh even harder at the joke, though.Report

      • Avatar Kazzy in reply to Russell Saunders says:

        Along similar lines, I remember watching “Undercover Brother” in theaters with a white friend. We were two of very few white people in the audience, with many of those beings with groups of black folks.

        There were a number of times where the bulk of the audience laughed and we didn’t, either because we missed the joke or felt uncomfortable laughing at it. There were a few time we laughed and the rest of the folks didn’t. We got glares. It was an enlightening experience.

        Is your girlfriend from Austin/Texas originally?Report

      • @drs I’m gonna give this one last shot, then I’m closing up my computer for the night.

        You and I are making the same point. The New York Times is the entity that seems to be describing all racial/ethnic/gender/religious preferences as equally reflective of bigotry, when in fact I thought I made clear in my post that they are not. The study they cite makes the same point you do, the same point I try to, and the opposite point to theirs. That what I am trying to say in my post.

        Did I confront a request for a specific ethnicity when assigning a physician to a patient that I judged to be racist? Yes. Under the circumstances, the details of which I have omitted and which might have been illuminating (but which might also have been distracting), I stand by that judgment. But my point is that such requests strike me as very rare, and even more rarely are actual racist requests accommodated.Report

      • She’s from Queens. Jamaica Queens, to be exact. Just down the street from where 50 Cent was shot, to tie it in with your Monday Trivia Question ;).Report

      • Avatar DRS in reply to Russell Saunders says:

        Yes, Russell I agree we are making the same point. I wondered when you’d notice.Report

  4. Avatar Shazbot3 says:

    Great post.

    I’d say the relevant distinction is this:

    1. If you think such and such a doctor from such and such a race or gender or sexual orientation won’t do a good job, that isn’t something the hospital should care about or help you with. You do not have a right to get care from a doctor from one racial/ethnic/gender/religion/orientation group and not another. And if hospitals routinely accede to these requests, they will be effectively enforcing racial/religious/gender/orientation discrimation against certain classes of doctors, so there is a reason not to do it.

    2. If you can demonstrate that seeing such and such a doctor of such and such a group is likely to cause you emotional distress or harm in your community, the hospital may decide to try to meet your request (though you do not have a right to demand that they meet it), provided that routinely accesing to such requests does not create more than a modicum of discrimation against minority and female doctors in your community.

    Such documentation could include a letter from a psychiatrist or psychologist. A signed affadavit from more than one friend or a local religious or community leader.

    So for instance, if you have a letter from a local rabbi that says it would bother you greatly to have a male doctor, then the hospital will try and assign a female. If you have a letter from a psychologist saying that you were traumatized in the war and have anger at Japanese people, the hospital will work to help you have a non-Japanes doctor. The communities of orthodox jews and WWII veterans is small enough that it would not create an impact on doctors to accede to these requests.

    There is a danger that local anti-black racists would get letters from friends and local religious leaders saying they don’t want black doctors, but these requests would not be honored because if acceded to in general, they would have a negative impact on black doctors.

    Does that solve the problem?Report

  5. Avatar Burt Likko says:

    When an attorney works for a law firm, sometimes clients get in the door and we take their cases before we have a good idea of who and what they are. And sometimes peoples’ true colors don’t come out until they’re under stress. So it’s happened that I’ve been in court, where I’ve met the client for the first time, and the client will say something awful and objectionable. Attorney-client privilege binds me the same way HIPAA binds the doc.

    But let’s say, hypothetically, a client told me in the courthouse hallway, “Well, I should have known better than to rent to black people, it’s no wonder they trashed my house,” or “Would it help our case if I called immigration? Because I know at least two of them are illegals.” I might, you know, hypothetically, have to figure out how to confront my own client. The tactic I have chosen is to force a choice: “You need to keep a lid on that, because I assume you want to win this lawsuit. Now, I assume that when you walked in this door, the only color you cared about was green, am I right?” I’ve only had one such client be dense enough that I had to spell it out in greater detail than that.

    Within my firm, I’ve been given the right to fire clients who behave in this fashion past the point where I feel uncomfortable around them. Gratefully, I’ve had to use that privilege only a few times. I wish I had found a way to be as direct about the confrontation as the Doc describes here because it speaks to a higher level of moral courage and correction than what I’ve done, whatever differences in position the doctor-patient versus attorney-client relationship there might be.Report

    • Burt,

      Does an attorney have the same obligation to represent a client as, say, a doctor has to treat (all? most?) ill persons who come to him or her? It seems you have more wiggle room up front as to who you’ll serve.

      I read at some blog post somewhere (not at the League), that discussed some unsavory corporate client that Elizabeth Warren had taken, and the blog post author had said that lawyers have an obligation to take all who come for their services. I didn’t comment, but that author’s claim seemed wrong to me. (It’s also possible I’m misrepresenting what he said, too, and especially, there might be a comment to his statement that I’ve either forgotten or didn’t grok to begin with.)Report

      • A public defender has an obligation to take whatever cases come across her desk, unless there is an actual conflict of interest. Most other kinds of lawyers, in theory, have the ability to accept or reject clients as they please.

        I’m sure you noticed my use of the phrase “in theory” in the previous sentence. That’s because a lot of lawyers’ ability to accept or reject clients faces practical rather than ethical limitations. In my case, my firm uses flat-fee eviction services as a means of attracting clients. The case intake, conflict screening, and most of the early paper workup is done by a paralegal. The paralegal does not have substantial discretion as to who to accept and who to send away. I don’t see the files until the day of trial in many cases.

        That gets to another significant limit on a lawyer’s ability to accept or reject work. Once a client relationship is formed, and the attorney represents that client by way of filing something on that client’s behalf with a court, the attorney cannot simply quit working for the client, at least not without the court’s permission — and I’ve had situations where a client and I had a falling-out and no longer wanted a relationship with one another, but the court would not relieve me of my duties as counsel. If the case gets very close to trial and changing attorneys would cause a substantial delay, substantial expense, or substantial loss of the client’s ability to present her case in trial, the court will deny the lawyer the ability to withdraw from a case.

        Of course, there’s the financial incentive, too — if you’re too choosy about who your clients are, you’ll never have any work and then you’ll starve. There’s also the problem of finding the client whose behavior is perfect — such a client is never in any trouble and so has little work to hire you to do.

        The Doc or other medical professionals would know better than I, but I suspect that those working within the discipline of emergency medicine have less discretion about who they take on as patients than other disciplines.

        One thing is very clearly in common between medicine and law — there is no rule that the professional and the recipient of the service have to like one another.Report

  6. Avatar Brandon Berg says:

    Call me a bigot if you want, but I’ll lie down in a gutter and die before I let an Episcopalian operate on me.Report

  7. Avatar Chris says:

    Russell, here is the full study.Report

    • Thanks, Chris! I appreciate your going to the trouble to get that for everyone.

      I’ve only had time to skim through it, but my first cursory reading confirms my impression from the abstract: providers are actually much more apt to accommodate minority patient requests for a provider similar to themselves, and the Times is misrepresenting its findings rather grossly.Report

      • No trouble ‘tall. It’s what I do.

        Anyway, you are correct that the study shows that providers are more likely to accommodate minorities, women, and Muslims:

        Overall, patients of minority backgrounds had signifi cantly greater accommodation scores than those from majority backgrounds. Female patients had greater accommodation scores than male patients (3.12 vs 3.02; p<0.0001) and non-whites than whites (3.08 vs 3.03; p<0.05). Furthermore, paired comparison across different patient demographics revealed that Muslim male patients had statistically higher scores than Black, Hispanic or Jewish male patients and Muslim females had the highest score across all demographics.

        Granted, this is on a Likert scale, and I’m not sure how important a different of 5 hundredths of a point on a 5-point Likert scale is, but whatever. I’m not going to get all methodological on this.

        I can’t really gauge, from the Times article, whether they’re trying to imply something other than this, or whether they’re saying that any accommodation of this sort on race/gender/religious lines might be racist or discriminatory in a negative way in order to make the issue seem more sensational. If they are doing that, then they’re making value judgments that the research, of course, can’t address (with its 5 hundredths of a point on a Likert scale).Report

  8. Russell,

    I have a comment about your opening anecdote. You had, in my opinion, every right to ask that man to change his shirt or cover it up. But you wouldn’t have been right–again in my opinion–if you had threatened not to treat his son unless he changed the shirt. I realize you didn’t say you would make such a threat, and I don’t think you would, either. But I think it’s worth mentioning that a doctor wouldn’t have the right to do that.

    Or am I wrong? Would I feel differently if the shirt had a Godwin-style logo or if the person, for the sake of argument, were dressed in a white hood? I imagine if the doctor feels a threat to his or her safety, he or she has the prerogative to demand a safe condition (perhaps in this case, an acknowledgment by the offending party to shed the offending apparatus). (For the record, I didn’t do the basic online research to figure out what the t-shirt actually said. If I had, maybe I would feel differently even in the case of your anecdote.)

    Just to be clear, you didn’t threaten not to treat the patient, and I don’t think you would. But I wonder if there would be a time where such a threat (or refusal, to use a less loaded term) would be appropriate.Report

    • I would never refuse to treat a patient, no matter how odious I found him or her, unless there were a proximate threat to my safety. It would have been unethical for me to have refused care in this case. If the T-shirt had said something like “Kill Fags on Sight” (I have never actually seen such a T-shirt, but let’s pretend), I would probably demand it be removed and insist on a security guard being present with me at all times when I was with the patient, but refusing to treat would never been the correct answer for me.Report

      • Avatar Kazzy in reply to Russell Saunders says:

        “I have never actually seen such a T-shirt…”
        Note to self…

        More seriously, is your ability (legal, ethical, or otherwise) to refuse to offer treatment different in the hospital versus in the office? Would it be different if the patient him/herself was the one wearing the shirt, as opposed to the parent of the patient?Report

      • No, my ethical obligations do not vary by venue. The ethical imperative to treat all patients is pretty concrete.Report

      • Avatar Pinky in reply to Russell Saunders says:

        But don’t you think you left the patient’s dad feeling like he couldn’t trust you? You called him out on the worst day of his life, and put him in a situation where he couldn’t be sure if your antagonism toward him would put his son at risk. Likewise to the Indian pharmacist – you’re a customer service employee. The customer is always right. It’s unprofessional to challenge a customer even if he’s saying terrible things.Report

      • Avatar Kim in reply to Russell Saunders says:

        Pinky,
        but it is absolutely professional to charge the customer 10times the going rate.
        … at least, that’s how they teach it in business schools.Report

      • @pinky I disagree with you entirely.

        First of all, I had to elide many of the details of the first story because of respect of patient confidentiality/HIPAA. I can assure you it was not the worst day of the father’s life. Had his child been rushed to the hospital following massive trauma or some other life-threatening emergency, I would quite possibly have decided to leave the conversation about the T-shirt alone.

        Patients are not customers, and they are not always right. Medical providers err if they think that way. My patients/their families often come in with demands or expectations that are medically inappropriate, and it is not my job to defer to them out of some sense of customer service.

        But let’s say you are correct in conflating patients and customers. I would never, ever expect a black person to silently tolerate racial slurs from a customer in any business. I would never expect a woman to tolerate sexual advances from a client or customer at her place of work. And I would never tolerate a patient demeaning any of my office staff for their race or religion or gender. I would sooner ask a patient’s family to seek care elsewhere.

        Being a customer is not a free pass to be a bigoted asshole.Report

      • Avatar Pinky in reply to Russell Saunders says:

        Yes it is. It shouldn’t be but it is. It’s your responsibility to treat people as they are. If anything, I’d give a medical professional less latitude than a pizza deliverer because the customer probably doesn’t have other options.

        And I know we’re not going to see eye-to-eye on this, but I respect that you can’t give full details, and I’m sorry if I’m putting you in a position where you can’t provide evidence to back up your position.Report

      • @pinky It is my responsibility to treat them. It is not my responsibility to silently tolerate abuse from them. It is nobody’s responsibility, from the kid taking orders at the local Sonic to the woman answering the phones at my front desk, to subordinate their dignity as persons to the bigotry of a customer. Some choose to do so for whatever reason, but none must and I never would. I marvel that you think otherwise.Report

      • @Pinky – the thing is that this ignores the sensitivities of other customers or patients (I agree with the Doc that the two should not be conflated for purposes of this discussion); the customer isn’t right when they are making things unpleasant for other customers.Report

  9. Avatar zic says:

    A couple of weeks ago, I was at the local pharmacy to pick up a prescription. There was a couple in front of me. She was obviously in some agony, and they were seeking a prescription that her doctor (from away) was supposed to have called in. But hadn’t.

    During the three or so minutes they were there, her husband managed to blame this 1) on his wife’s female doctor, 2) on the doctor’s female nurse, 3) on the incompetent female pharmacist 4) on the incompetent female pharmacist’s assistant he was talking too, and 5) on his female wife.

    And not one of us, the pharmacist, the assistant (a friend of mine), the wife, or I confronted this obnoxious man about his overt and disgusting misogyny. The lack still troubles me, too.

    Yet what would it have accomplished? It wouldn’t have made the prescription appear in the system any faster; it wouldn’t have relieved the agony the wife was obviously experiencing, it wouldn’t have made the pharmacist or the assistant more competent then they already are (and they are competent). All it would have done is made a self-righteous and rude man feel justified in his rudeness, or so I suspect, and it might have made him further abuse his wife in some weird sort of revenge.

    I asked my friend, the assistant, about it a few days later. She said this happens; not often, but with some regularity. And no matter the variation, the standard within the shop is to pretty much ignore it, to just continue being professional, and be grateful most patients are polite.

    My sister, a nurse who provided critical care in a pediatric ICU for many years, tells me that the stress of a child’s illness often brings out the worst in families; and she realized early on that a big part of her job in caring for those extremely ill children included managing the worst behaviors of their stressed parents and siblings. She has some ability to meet their fear with comforting humor; and an amazing ability to quickly point out that certain behaviors are rude without seeming to be saying ‘you’re rude.’ (I think this might be part of what we call bed-side manner?)

    I would probably let an offensive tee shirt slide and likely greet requests for specific gender or race with a firm no; suggesting they hire private care if that’s more important then the immediate crisis.

    But I’d still like to tell that man at the pharmacy what a jackass he was.

    And I wonder how anyone thinks a tee shirt that’s intended to insult a specific class of people is a good idea?Report

    • Avatar Jim Heffman in reply to zic says:

      “I’d still like to tell that man at the pharmacy what a jackass he was.”

      It’s like those parents who bring loud noisy kids to a restaurant where *I* want to *eat* in *peace*. Don’t they understand how disruptive it is when their baby screams? I usually go over and give them a piece of my mind.

      Or like people who fart in public. DEEEEEE-SGUSTING. I always tell them how rude they’re being to complete strangers.

      Or someone who says–out loud! Where anyone can hear!–that they don’t consider homosexuality to be a mortal sin. I make certain they understand their error. I mean, we can’t let people with awful attitudes go uncorrected, right? They have to know that they’re *wrong*, otherwise they’ll keep on doing it!Report

      • Whoopsie. It seems like you missed this thing that zic wrote:

        Yet what would it have accomplished? It wouldn’t have made the prescription appear in the system any faster; it wouldn’t have relieved the agony the wife was obviously experiencing, it wouldn’t have made the pharmacist or the assistant more competent then they already are (and they are competent). All it would have done is made a self-righteous and rude man feel justified in his rudeness, or so I suspect, and it might have made him further abuse his wife in some weird sort of revenge.

        Or perhaps there’s some other point that you’re trying to make?Report

    • Avatar Pinky in reply to zic says:

      A pharmacist friend of mine tells me that the two worst patients are the ones waiting for migraine medication and birth control pills.Report

  10. Avatar BlaiseP says:

    Lotta doctors in my extended family. I’ve heard such stories before, years ago, back when bigotry was far more common and far more accepted. Tale was told of a hospital administrator who’d recently come round on the subject of racism, took him quite a while to get there. This was the early 70s. He had a history of petty bigotry. Often it takes on the form of a cruel little game, “enforcement” of non-existent regulations, that sort of thing.

    So this guy stopped being such a racist dick and turned his life around in other ways, too. The rest of the staff noticed it, too. Some of his old racist buddies stopped dealing with him on such friendly terms: there was a price to pay for such repentance. But he made other friends and my uncle was one of them. And the black staff at the hospital noticed. He never really came out and made a big deal of it, he just stopped being a dick. And on the strength of his convictions he went back and righted several wrongs he’d done.

    It was people like this guy who changed everything for the rest of us. Small acts of decency change the world.Report

  11. Avatar Kim says:

    Here we balance the Hippocratic Oath against our desire for a level playing field for everyone.
    I’ve got to ask: how much of a risk of death are we willing to put up with, in order to create a level playing field?
    (disc: any answer’s fine. it’s a hard question)
    If the racist guy is likely to have a heart attack (or psychosomatic allergic reaction), do we indulge him?
    We are effectively providing care that might substantially distress someone, perhaps even to the point of death.Report

    • Avatar Jaybird in reply to Kim says:

      Actually, I see it more of “how do we see health care?”

      If we see it as a good or service that is provided when we pony up payment, I imagine that we’d have every right to say “and I want my doctor to be blonde” at the end of our list of wants. And if they don’t have doctor who is Scottish, watches the same shows that I watch, has hairless hands, and is blonde… well, you ask “what do you have?” and hope that they have your second or third choice on the shelf.

      If, however, we see it as a good or service that is provided to us as part of the things that we have agreed that we have various rights to, then we get what we get and we don’t get upset. Any accommodations made within the available doctors are a courtesy and nothing more. Now sit back down. We’ll be with you shortly.Report

      • Avatar Kim in reply to Jaybird says:

        I like your framing better.Report

      • Avatar Kazzy in reply to Jaybird says:

        In the former scenario, doesn’t it behoove the patient/customer/whatever to seek out the appropriate doctor? I can’t walk into Pizza-Hut and demand sushi and cry foul when they don’t supply it, no matter how much money I offer them. So if someone wants a blonde dermatologist, they are free to doctor-shop to their heart’s content. But they can’t walk into Dr. Smith’s and object to her auburn locks.Report

      • Avatar Jaybird in reply to Jaybird says:

        We see many cases of folks shopping around for Primary Care doctors (heck, I can tell you now that we shopped around for ours).

        We did so at our leisure and made sure that all of the stars were aligned (insurance, they were accepting new patients, etc) and we got the one we wanted.

        Which strikes me as different than the time that we went to the emergency room.Report

  12. Avatar dhex says:

    i’ve only run into this issue once, and it wasn’t so much about care for a specific religious group but our patient education materials. the cover of one publication involved a woman in a white t shirt – it was not risque by any stretch but you could tell she had breasts.

    i fought and lost on that one, because the group in question was only 10% of our patient base for that service line but who tended to be fiercely loyal when it comes to other services. and because one of the doctors who complained was much higher on the pole than i. so it became one of those things where poop rolls downhill, mostly from the two admins who had approved the design three months earlier and had apparently gotten chewed out by this guy, who though adamant was not rude in the slightest to me.

    they were both female and i’m male, so that was no doubt a factor. i am also a pituitary freak so that tends to dampen male doc rage.

    however, it hasn’t been an issue since then and i was able to deflect a similar complaint, having a stronger position at that point. but it still bothers me, even though i understand the business issues and the need to be sensitive to cultural expectations.Report

  13. Avatar bluefoot says:

    This is an interesting post. My sister (who is a physician) has encountered this both from patients and from other staff, particularly in the first couple of years post-9/11. She’s brown, and it’s hard to tell her/our genetic background just by looking. (Our ethnicity, if any, is East Coast suburban American). When she moved to the Midwest post-residency, she got patients who asked for another doctor because she *had* to be a terrorist sympathizer. Typically the other doctors supported her, and it was rare that the situation escalated. However, she also had staff at the same hospital ask her about how she felt about 9/11 i.e. did she approve, or they would make racist comments. (Her answer usually shut them up: on 9/11 she was working in a Manhattan ER while she waited to hear if her first responder husband was okay.) The comments from staff pretty much stopped after the first year. FWIW, she says she hasn’t had any problems since she’s moved to a major city,Report

Leave a Reply

Your email address will not be published. Required fields are marked *