Confronting Racism from Patients

As physicians and health care workers, we are expected to see patients of all different backgrounds and walks of life with the expectation to treat them with the utmost respect and provide them with the highest level of care possible. However, physicians of color face a unique challenge when encountering patients who voice racist views or refuse care on the basis of their practitioner's race. We can find our oath to provide care for all patients to suddenly be in opposition with concern for our mental and even physical safety. Unfortunately, due to the longstanding structural racism of medicine as an institution, physicians of color are rarely, if ever, taught what to do in these situations. Furthermore, they often have little to no support structures to turn to when these events occur.

My first exposure to this challenge came during my internal medicine rotation as a third-year medical student. A patient had been transferred to our team after he refused to be interviewed or examined by his previous doctor for being non-White. Ironically, while our attending was White, the senior resident, intern, and medical student were all non-White. Our attending was gone for a meeting until later in the afternoon, and the patient needed to be assessed after having transferred services. The intern and I went to introduce ourselves to our new patient. Instantly as we walked in, the patient gave an angry and exasperated cry.

"Where the hell is my doctor? I was promised a White doctor, and I am not talking to anyone who isn't White."

The directness of his demand caught me offguard. I had anticipated pushback, but this was beyond what I had prepared myself for. I took a deep breath and reminded myself that he was still my patient. It was my duty to examine him. After all, I reasoned that he might be mentally altered from his illness, or the stress of hospitalization might have been making him more anxious. So I re-introduced myself again and tried taking his history. He immediately cut me off and grabbed the ID on my lanyard.

"Amin, eh? That some kind of Arab name? Why are you, a fucking dirty Muslim, here taking care of me?"

As an Iranian-American, this was not my first time dealing with racist slurs. Nevertheless, it was a new experience to be judged unworthy to treat someone based on my name. The rejection stung, and I could not help but internalize his hatred towards me. I cleared my throat and tried to redirect him, but then he quickly began ranting about his theory of racial relations.

"All you foreign doctors are ruining this hospital. Why don't you stay in your home countries and not ruin our cities? I want a real doctor. A White doctor!" He refused to let go of my lanyard and continued to ramble about the inferiority of all non-White races until my intern managed to help pull me away. We left shortly after, feeling defeated with nothing to present to our attending. The attending told us not to worry about the patient and that he would personally take care of the patient. Still, I fundamentally felt that I had failed as a medical student.

Disappointed by the events that had transpired, I shared the experience with several of my professors. I explained how I felt regret that I was not able to provide care for this patient even though he was directly racist towards me. The most common response I received was that I should simply avoid racist patients. It would be a fact of life that I needed to accept, and the easiest solution was to remove myself if a patient was being aggressive or discriminatory. Their answers seemed cold and distant. I felt they did little to help equip me with strategies for future situations. Similarly, when I mentioned the case to several of my classmates, they appeared to be uncomfortable even acknowledging that such a situation could even occur, that a patient may refuse care based on their provider's race. After turning to my teachers...