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In the acclaimed movie “Hidden Figures,” the main characters — three black mathematicians who are women — struggle to be accepted for who they are and the work they do in a world that isn’t prepared for expertise and authority that’s young, female, and black. Fast forward more than 50 years, and in my experience as a first-year resident at Cambridge Health Alliance, very little has changed.

A few months ago, we were treating a patient who was not permitted food or drink because she would soon undergo surgery. In discussing her case with my attending and her surgery team, it became clear that we didn’t know when she would be scheduled, so we decided to go ahead and let her eat. I placed the order so she could have something if she wanted.

A male nurse working with me said no and would not fulfill the order. He was older and white.

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I deeply respect nurses’ opinions; they spend a lot of time with patients, and their clinical instinct and experience is invaluable. I took his concerns to more senior doctors, but they disagreed. I informed the nurse that we recognized his concern, but had decided to stay the course. He again said no.

My pager went off and I used it as an excuse to gracefully exit this awkward conversation. My orders were being disregarded and I didn’t know what to do.

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Recently, I was jotting down notes on medications for a patient whose lungs were filling with fluid, when his friend, a middle-aged white woman, slapped my hand.

I dropped my pen in shock and looked up at her in disbelief.

“Illegal abbreviation,” she scolded, waving her index finger at me.

As if I was a dog who had gotten into the trash instead of the doctor trying to treat her friend’s dire condition.

This woman gave me a lecture on which shorthand was allowed and which was frowned upon. She was emboldened to do so because, she said, she used to be a nurse. I simply picked up my pen and carried on.

Her touching me was especially galling because, while treating her friend, I had been careful and respectful in putting my hands on his body:

“If it’s OK, I’m going to do a physical exam.”

“May I use my stethoscope to listen to your heart?”

“If you don’t mind leaning forward, I’d like to listen to your lungs.”

Yet his friend, a former clinician, hit me. She disciplined me, as if I was a child — as if I had no authority to be in that room, caring for her friend. She put her hands on me, a stranger, without asking if it was OK.

In both of these cases, my authority and autonomy were challenged. Was it because I was young? Because I was black? Because I was a woman?

Black women constantly deal with the indignity of not being taken seriously by white people whose privilege towers over them in society. In the hospital, however, the power and privilege are mine. As a doctor it is my responsibility to make decisions that ensure my patients’ medical needs are met. As a trainee, I recognize the complexity of our conflict: outside the hospital, the power was theirs. Inside, it was mine, a young black female physician.

Maybe they preferred the status quo that kept me, the hidden figure, hidden.

In the case of the male nurse who refused to fulfill my patient order, I had to ask my attending physician to intervene.

In the case of the woman who slapped my hand, her microaggression broke both professional and personal boundaries. I felt too humiliated to tell anyone about it.

In both cases, I had to reckon with a lack of respect that went well beyond my role as a trainee. I’ve had to ask myself, when are we allies with our colleagues and the people we treat? When are we at odds? Why do I even have to ask this question at all? I have to figure out how to be a good doctor, while sorting through the social dynamics I’m subject to as a black woman. This is something I’ll have to navigate my entire career, while many other residents will grow into the respect they’ve earned, without question.

During this Black History Month, I’ve been reflecting on how my race and gender intersect with the extraordinary responsibility I have for my patients’ health. It has made me realize how I often choose to please others at my own expense because I’m trying to make them more comfortable around me and my role in the medical hierarchy.

As a physician, I’m learning that I need to lean into my authority and counter any force that threatens to undermine it, because one day I will be an attending and doctors-in-training will look to me for leadership, guidance, and support. By putting myself first, as a black healer, I truly believe I’m putting my patients first.

  • based on your previous posts, i’m seeing a disappointing pattern here. perhaps you should try less whining and more standing up for yourself?

  • I’m going to take my comment in another direction and say that I first respect what you do, and thank you for it. I also want to remind you that this is YOUR journey! Live it, experience, and learn from it. All of these instances in the hospital not only start dialogue here, but they give you a foundation to build and make note of what you will and will not deal with in the future. You probably don’t hear this enough, but you are doing GREAT! This field isn’t for everyone, including those that have many opinions about what you should and should not be doing. I enjoy reading your articles and look forward to reading more. Keep working and learning :).

  • Doctor, your story about the former nurse who put her hands on you calls to mind for me an incident from over 35 years ago. I was then a Major on active duty with the US Air Force in Germany.

    While walking on base, I observed an interaction between a young black Airman Basic and a female black Staff Sergeant. As the two of them passed each other on a sidewalk, the airman looked over casually at the sergeant, waved and remarked quite audibly “Hey Baby, how you doin?” The Sergeant continued past him a few steps without responding. At that point, I called out in a parade ground voice, “Atten-SHUN!” from across the street. After looking my direction, both stood in place while I walked across the street.

    I first addressed the Airman. “Airman, do you know why you are being stood at attention?” He shook his head silently. I added, “I don’t hear you Airman.”

    He sighed and spoke “No Sir.”

    I replied “You are being reminded that the Sergeant is senior to you in service and experience, and is due your visible respect to acknowledge that fact. This is a habit that you need to get into and it has nothing to do with hassling you. We first learn to respect ourselves by respecting others and accepting their earned authority. If you fail to learn that principle, then you will sooner or later be eliminated from service as unsuitable. ”

    I then asked the Airman what unit he worked in and received his answer. I followed with “Airman, you are dismissed. Sergeant, stand at ease for a moment, please.”

    When the Airman had saluted and received my salute in return, he walked down the street, shaking his head faintly. I addressed the Sergeant. “Do you know why I want to talk with you, Sergeant?” She shrugged and said “I think so, Sir.”

    Then I added, “Then let’s resolve any uncertainty. That kid and others like him need your leadership. He’s likely never been taught to respect much of anything, and you weren’t helping him today by cutting him slack. You’re not an NCO to win a popularity contest. You have been promoted to lead and teach others. You can’t do that if you let them diss you as a woman in authority over them. You don’t have to come across as a hard-ass, but if you’re going to thrive in the Air Force, then you’ll need to assert yourself when you run into guys who have a lot of attitude. It’s not about lording it over “the brothers”. But if you tell them to jump, they shouldn’t have to ask ‘how high’.”

    “This time the lesson is free – no harm no foul. I very much hope that nobody has to repeat the lesson again. If you need help, then go to a senior NCO in your unit and ask about assertiveness training. And if you see that young man again, then look him in the eye and verbally nail his ass to a wall if he doesn’t get the message. It’s something he has to learn.”

    I dismissed her and we saluted each other. Three years later I saw her on the street again – as a Technical Sergeant, promoted one grade. We didn’t speak, but her salute seemed especially sharp.

    That said, it’s a little remarkable to me that so little seems to have changed in the culture in 35 years.

  • Former nursing administrator here:

    If an RN refuses a physician’s order, that nurse must express the specific reason why. Did you try to elicit this from the nurse? If so, was the answer based on accepted evidence? If this communication didn’t happen, you should feel comfortable in initiating it. A refusal without explanation is unacceptable, and you could also escalate that on the nursing side by asking for the nurse manager or clinical director to respond.

    As to the visitor who slapped you – now that the shock of the moment has passed, you might want to plan how you will respond if someone makes another attempt to touch you without permission. Personally, I take a step away to be farther than striking/kicking distance toward a door. I tell the person calmly and firmly not to touch me. And I explain that another attempt will be grounds for immediate removal from the premises by security. I make good on those statements. If the patient is in danger, I call security from the nearest safe place or even press a code button. The idea is to get people there who can put distance between you, the patient, and the attacker while calling security/police.

    A course in non-violent communication and de-escalation techniques was very useful to me in dealing with agitated, angry and disruptive people.

  • Personally, I’d like to hear both sides of each story before I make any conclusions. Trainee/resident conflicts are common, particularly in large academic centers. As a program chief, I’ve seen enough of these to know that each person has a story that makes them look like the victim.

  • It’s not because you’re black , it’s because they’re nurses. They have no respect for physicians anymore.

  • What you describe (the former nurse striking you) is punishable under Massachusetts General Laws, chapter 265, section 13. It is assault and battery. Please head down to your local district court and file a complaint. This should not be tolerated – ever. To permit this is to encourage repetition. When the complaint comes up for hearing, advise the clerk that you will settle for an apology from the former nurse and a promise to never strike another person again. You will achieve the necessary end without needing to seek prosecution. Hospital counsel should be willing to do this for you AND cover the date; you need not appear (or use your time in that manner).

    • No, she should not challenge that male nurse unless she is prepared to leave the hospital situation. He might use his influence to frame her as “disruptive”, a “bitxx”, or other vengeful endeavors. Hospital administrators are not likely to back up powerless lady professionals at the bottom of their revenue stream.

    • While I agree on the nurse that did not follow her orders – the former nurse who struck her is not in that same position – this is a former clinician not employed with the facility.

  • In the case of the patient whose friend put her hands on you, I believe that you missed an opportunity to correct unacceptable behavior and possibly compromised your own credibility.

    By doing nothing, you validated the friend’s actions as being okay. Heaven forbid she feels justified to engage in the same behavior with someone else.

    As a patient, your response would have led me to question your competence. I don’t mean to be harsh, but I would have begun to second guess your recommendations/actions at that point.

    • Actually, maybe she should just go around slapping strangers until she runs into the wrong one.
      Then it’ll be her luck to be in a hospital.

  • Although both of the examples were clearly wrong believing that “In the hospital, however, the power and privilege are mine” is also a very dangerous belief as well and can lead to errors and patient harm.

    Your role is to lead through service of the patient not by power over others and you are emboding the very power dynamic that you so detest.

    It is common for people who have been abused to become abusers themselves if they aren’t careful.

    • What a ridiculous comment, given the content of the story! Where the heck are you coming from, “Healthcare isn’t about power” person?

      Your comments about “abused becoming abusers” are TOTALLY out of line and not warranted by the very balanced and perceptive story.

      And I’d give this physician kudos also for “service to the patient” by not issuing unneeded “nil per os” (NPO) orders! That’s rare, and excellent!

    • Your response misses the authors point totally. The patients friend has no standing – let alone power – to slap this doctors hand. In a hospital the staff – doctors, nurses, folks who work there – are in power. Some white folks think the privilege that their skin color gives them in society overrules everything. There is nothing – absolutely nothing – that the author wrote that indicates she has or intends to abuse her power. Seems you struggle with giving up your privilege/power too.

  • Wow, in the case of the nurse disciplinary action should have been taken. First a nurse no matter what gender or race should be disrespectful, second doctor’s orders are just that Orders, if the nurse feels order is inappropriate they may decline but must document why and be prepared to face discipline. Third, physician should have written order and giving to nursing supervisor if nurse continued to refuse. The “friend ” of patient was definitely out of line, but rather than being intimidated or victimized,physician should have responded with shock and asked friend to leave. I am concerned about how a confidential record was so easily accessed by friend while doctor was still documenting? Any way no matter gender or race one should not tolerate bullying( intimidation) in workplace be it from subordinates, colleagues or clients.

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