Every Wednesday, my medical school classmates and I swarm the wards and primary care clinics of nearby teaching hospitals, taking histories, fumbling through physicals, and slowly learning to practice the art of medicine. As I talk with a patient and run through my standard list of questions, there’s always one section — place of birth, nationality, and immigration — that I skip.
My reasons for not gathering that information are varied: potential embarrassment for the patient, an awkwardness that could disrupt the flow of the interaction, and now the acute anxiety that asking such questions raises. I rationalize that the answer to a question about nationality won’t influence the treatment of the patient in front of me, and that information about country of origin will emerge somewhere downstream in his or her care.
Last month in Texas, the answer to the question about country of origin ripped Sara Beltrán Hernández out of her hospital bed, her hands and feet bound in restraints. An undocumented asylum seeker who was fleeing gang violence in El Salvador, this mother of two had been held in the Prairieland Detention Center in Alvarado, Texas, since late 2015. In February 2017, after collapsing from severe headaches and nosebleeds, she was transported to a local hospital, where doctors found a brain tumor that needed emergency surgery.
Just days before the operation, US Immigration and Customs Enforcement agents removed Beltrán Hernández from the health center against her will. Thankfully, after intense legal efforts, she was released a week later to her family in New York, where she will seek further treatment for her tumor.
The case might be the first where President Trump’s newly empowered ICE officers forcefully removed a patient from hospital care. With executive orders that decreased the threshold for deportation and banned migration from six Muslim-majority countries, the new administration’s policies have stoked fears within the health care community on whether people affected by these orders will seek the health care they need. In the Boston area, clinics supporting immigrants and refugees have already noticed an uptick in missed appointments, and providers are left wondering how best to advocate for them.
Training to be a physician during this era of xenophobia has been emotional, jarring, confusing, and more. Growing up and watching my Sri Lankan-born mother, a pediatrician, care for patients of all colors, I was drawn to the idea of working in the diversity of this country, to the openness the profession was founded upon, and to the embrace of immigrants as American. Those aspirations are why I am so disheartened by medicine’s relative ambivalence about today’s political agenda.
While lawyers and judges have tackled President Trump’s executive orders with vehemence, and police forces have vowed not to work with ICE, medicine as an institution has remained largely silent on how it will protect these vulnerable patients.
The day after Trump was elected president, my clinic operated in hushed tones, a whispered conversation with my preceptor serving as the only acknowledgment that the reality outside was indeed “unbelievable.” This mentality has lingered, with physicians’ personal perspectives subject to HIPAA-like secrecy, and political correctness seen as the antidote for political incorrectness.
Perhaps medicine cloaks itself too tightly in the white coat’s neutrality — waving it like a white flag above the messiness of politics. But the new administration’s policies have already attacked American health care. The travel ban affected thousands of immigrant doctors and the ability to see their families. Numerous medical students are unsure of a future in this country. The hallowed Dana-Farber Cancer Institute is struggling to separate itself from the Trump presidency after holding a fundraiser at his Mar-a-Lago resort. And a patient suffering from brain cancer was physically removed from a hospital before she could have an operation to remove her tumor.
Many physicians are reacting to these assaults rather than preventing them. Thankfully, some doctors and students have taken up the call, but broader swaths of the medical community need to push back against the administration before it further isolates marginalized patient populations.
In Trump’s address to Congress last week, he deepened his hard line against immigration while alluding to a national milestone nine years from now. “What will America look like as we reach our 250th year?” he asked. I hope it’s exactly how it looked a quarter millennium ago: a nation full of immigrants.
Sandhira Wijayaratne is a first-year student at Harvard Medical School.
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As a physician, it seems concerning that you don’t take into account a patients nationalityy, ignoring the differing risks and rates of diagnoses among different ethnic backgrounds.
Fourteen percent of Hispanics have been diagnosed with diabetes compared
with 8 percent of whites. They have higher rates of end-stage renal disease,
caused by diabetes, and they are 50 percent more likely to die from diabetes as
If anything, put the science before anything else, as this is what is best for patients.
Bro, nationality has nothing to do with ethnicity (e.g. a man of African descent born in England is still English, not African). The author didn’t say he doesn’t ask patients what their race or ethnicity is, which IS what’s necessary to consider when making health decisions/recommendations, not nationality. Don’t be so quick to judge, dude.
tRump’s health proposals, like everything else he plans, aren’t based in the real world that 98% of Americans live in… So no wonder that they cause horrific misery for many!!
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