“Idon’t want your kind taking care of me!”

To an outsider, it might have resembled a standoff from an old Western. But it was taking place in a most modern hospital: the patient, an older white man hunched over with a snarl distorting his face; the physician, a young woman with a patterned hijab wrapped around her head.

Minority physicians like me often hear patients make “your kind” remarks. In a collaboration between STAT, WebMD, and Medscape, 59% of 822 physicians surveyed reported hearing an offensive remark about a personal characteristic from a patient; the majority of these remarks centered around race, gender, ethnicity, and religion. Another 49% had patients request a different doctor based on some of these characteristics.

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In today’s climate of unbridled bigotry, some patients are becoming increasingly vocal in their disdain for physicians who don’t resemble what they perceive to be the norm: a white Christian male or female. It often translates into refusing to be cared for by a physician based on personal attributes like skin color, beliefs, and values — none of which have any bearing on the quality of care delivered. (Although this kind of racism or overt cultural fear is also directed against nurses and other health care providers, I focus here on the group I know best, physicians.)

I believe that openly voicing these prejudices originates from viewing health care as a commodity, a menu of services from which patients can choose the design and packaging of the care they desire. As a result, some patients feel entitled to dictate every aspect of the service, including their physician’s gender, race, or religion. But the key assumption underlying these choices — that the type of physician they prefer will provide better care — is not generally true.

Most physicians placed in the uncomfortable position of responding to requests like these defer to their promise to put patients’ needs first as encapsulated in the Hippocratic oath we all swear to uphold. But in giving in to prejudicial ideology, we also compromise our moral conscience because we know that such acquiescence is wrong. Providing healing while tolerating hate speech or discriminatory remarks and behaviors also erodes the basic tenets of the medical profession.

Acceding to such requests may also be driven by the competitive landscape of medical practice, in which metrics such as patient satisfaction scores influence reimbursement and promote an environment that I believe creates incentives for physicians to pander to patients’ requests.

In the United States, white is the predominant hue of the physician workforce. Blacks and Hispanics comprise nearly one-third of the U.S. population but don’t make up anywhere near that percentage of physicians. In addition, a growing number of U.S. physicians are Muslim. The historic whiteout of the profession is so ingrained in the American psyche that the expectation of white and black patients is to be cared for by a white physician.

Patient advocates might argue that patients should have a right to choose the kind of clinician they see, and denying them this right infringes upon their agency to make personal decisions about their care. But I believe there should be limits to the choices we give patients.

No one really knows if choosing a physician based on shared beliefs or values influences the quality of the interaction. If it truly improves patients’ trust or confidence in the care they receive and helps them follow their management plans, then it might be worthwhile to honor such requests. But if it doesn’t, then health care providers should engage in open dialogue in hopes of educating patients and providing them the best care.

Of course, not all requests for a different physician are expressions of prejudice or discriminatory ideology. A male patient may, for example, request a male provider because he feels more comfortable having a male perform an annual prostate exam or discussing sensitive concerns such as sexual dysfunction.

But what do we do when these requests are made in a different, more hostile spirit?

Unfortunately, the medical profession offers little guidance for how clinicians should handle blatantly discriminatory requests or comments from patients, leaving us ill-equipped to address such situations.

An article in the journal Academic Medicine offered a three-step approach for physicians faced with racism that included first assessing the severity of the illness or injury, then trying to cultivate a therapeutic alliance with the patient or family, and depersonalizing the event. But these provide actions to be taken after an incident has occurred. While workable, this approach puts the onus on the health care provider and does not hold patients accountable. It also does nothing to create an environment in which discriminatory attitudes, remarks, or behaviors are not tolerated.

It is time for the medical profession to do more to increase awareness among nonminority medical professionals of the challenges faced by their minority colleagues so they, too, can join efforts to advocate for change and help bolster a sense of belonging for minority physicians.

Acknowledging the problem of patient racism and making all practitioners aware of how common and harmful it is are the first steps. Beyond that, comprehensive curricula are needed for all trainees and health care providers that equip them with the knowledge to recognize discrimination in the workplace and what to do when it rears its ugly head. In addition, their medical institutions must stand ready to support them.

Deferring to a society still haunted by ghosts of its discriminatory past will hinder efforts to create and maintain a diverse workforce and an inclusive work environment in medicine.

Intolerance towards minority groups may sadly be the norm in our society. But in the hospital or clinic, intolerance towards such prejudice should be our unified response.

Uchenna Ikediobi, M.D., is an assistant professor of medicine in the section of general internal medicine and infectious diseases at Yale School of Medicine and practices medicine at the Veterans’ Administration Medical Center in West Haven, Conn.

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  • Does mean that the facility will be hiring male mammographers, more male nurses, and more male OB/GYNs to have a more diverse work force?

    Furthermore the Constitutional right of personal privacy (specifically in the choice of gender of patients’ healthcare has been legally upheld.

    In Backus v. Baptist Medical Center, the plaintiff was denied a transfer to the OB-GYN ward on the basis of gender. The court ruled that due to nature of the ward, an employee’s competence was secondary to the obvious “bodily intrusions” that would result from allowing male nurses. The court opined:

    Due to the intimate touching required in labor and delivery, services of all male nurses are inappropriate. Male nurses are not inadequate due to some trait equated with their sex; rather, it is their very sex itself which makes all male nurses unacceptable.

    The court stated that it does not matter that a nurse is a health care professional because he would be an unselected intruder on the patient’s right to privacy. It differentiated between a delivery room situation and instances where a female may by choice select a male doctor.

    If I don’t want a female provider fiddling with my junk, that is my legal Constitutional right.

  • I can’t count how many times I’ve received medical care from a physician different from me on nearly all major characteristics (except notably level of education attained). It’s been the norm my entire life. It’d have been impossible for me to request a person “more like me”, be it on the basis of race, ethnicity, religion, sex or country of origin. Now I’d be lying if I said that sometimes I wasn’t a little uncomfortable, usually because of an added level of communicative “work” I might have had to do on my part. But what was I to do—refuse care? Yes, I absolutely could’ve done so. Had I done so, though, I’d probably be unable to walk now. But it would have been my choice, right? Yes, absolutely, and my “right”. OK.

    And I certainly would NOT have been able to hold the medical facility or physician(s) responsible for any “malpractice” ensuring from my refusal to receive care on the basis of anything other than a documentable lack of medical certification. Right?

    Or could I?

    I mean, there’s an ethical question here: do you allow a patient to bleed out simply because she doesn’t want the available physician on call in the ER to touch her, for whatever reason? Under what circumstances does honoring a patient’s “right” to choose their healthcare professional place everyone in different levels and types of jeopardy? Medical ethics boards would have to consider these matters very seriously. Is the patient’s “preservation of life and limb” more important than his “sensibilities and preferences”, whatever they might be? Where’s the line to be drawn? Should it have to be in writing (like refusing transfusions, or extended life support)? How severe does a given case have to be to override such “preferences”?

    I’m suggesting here that there’s a very slippery slope. It’s quite easy to see it when it’s the physican or hospital refusing to provide care to a patient (the infamous case of blues singer Bessie Smith fatally bleeding out because she was taken first to a nearby whites-only hospital and refused care there comes to my mind). But when it’s the other way around, issues of ethics may also arise.

  • Racism does not equal different values. The term “colored” is a White supremacist term coined by white people of the Jim Crow south when public opinion made the use of the N word not as acceptable as it had previously been. So let’s start there, patients should not be allowed to use racial slurs towards physicians w/o consequence.

    Second, I agree that patients should be able to choose whatever kind of care they want. Who delivers that care however, should be a mattered determined by availability and expertise, not skin color. You lot here are a bunch of racist apologists for even reducing racism to a matter of preference! Saying I don’t want a Muslim doctor treating me because (enter some racist reason) is not the same as favoring a political party or liking dogs more than cats. The fact that anyone would even reduce such prejudice and racism to something so mundane as a hair style of food preference is also trash.

    The author here is not a bigot. Rather she respectfully highlights the abuse that underrepresented physicians face at the hands of patients who ironically need their help? So if a White doctor is unavailable and you need a life saving treatment only a Black doctor can provide, y’all are saying the hospital should leave the patient to die because he’s an old klansman? Ok.

    Also as someone who has been treated my ENTIRE life save a precious few experiences by doctors who are a different color from me I can resoundingly say, quality care is not determined by skin color.

    • You said: “The term “colored” is a White supremacist term coined by white people of the Jim Crow south when public opinion made the use of the N word not as acceptable as it had previously been.”

      I say: You are incorrect. At the time of its popularitu, “colored” was a respectful term.
      For example, the NAACP called itself the National Association of COLORED People.
      ————————-

      You said: “patients should not be allowed to use racial slurs towards physicians w/o consequence.”
      I say: (1) Who the hell are you to “allow” or “not allow” adult strangers to do anything?
      (2) What “consequences” do you want to inflict on sick and elderly people for their bad attitudes? Is that the job of the medical staff — inflicting consequences?
      Would the consequences involve withholding care?
      What about intentionally prescribing the wrong meds or killing their immune cells, as the Muslim doctor Lara Kollab suggested she would do?
      ————

      It’s too bad that patients don’t like her or want her for their doctor, but there is nothing rational that can be done to force them to accept her or anyone else.

      The medical staff has to accept patients where they are.

      They have no right to dole out “consequences” for opinions they don’t like, or to inflict mind control re-education on others.

      How well should the patient be to undergo a Gulag re-education?
      What if the person has been injured and needs surgery right away? If a patient experiencing a heart attack fires the first doctor for reasons that you do not think he should have, how much screaming by the medical staff should he suffer until he is re-educated enough? How long a delay before treatment can begin?

      How well do you think the staff would fare in a jury trial if they were sued for delaying care in order to inflict “consequences” for a bad attitude?

      It is not your right or in your power to edit the contents of the minds or hearts of others.

      Your hubris is potentially fatal for all the bad people, and you have no right to demand it.

  • The author mentions that the other doctor didn’t berate the patient who called a doctor “the colored girl.”

    But is correcting patients’ social attitudes part of medical care?
    What about the patient’s political opinion?
    Suppose he is wearing a campaign button promoting the wrong candidate?
    Should the medical staff re-educate him on that too?

    What if his clothes are poorly chosen, or his eyeglasses unattractive?
    What if he is still wearing a mullet?!?

    Does he have a dog charm on his key chain when he should favor cats?
    What if he mentions that he dislikes Caribbean food?

    What exactly does the author think the doctor should have said to punish the patient who referred to her as “the colored girl”?

    How would a doctor have the authority to do so anyway in the first place?

    And isn’t the doctor’s sole function to provide medical care no matter who the patient is going to vote for or to distrust?

  • I agree with Marion and Zane’s responses above so I will not repeat their points. While racism and bigotry are indeed ugly, and I will note that I have welcomed medical care from physicians of diverse backgrounds, I find this opinion piece chilling. Diversity does not guarantee you a right to my body no matter how much this distresses you.

  • The author, not the patient is the bigot—his/her beginning principles is faulty—having a preference and/or different values is not the definition of being
    prejudice or wanting discrimination—it’s a preference—I prefer dogs over cats does not mean I’m somehow prejudice against cats

    • Well, to be fair, even if it is the expression of a “preference,” the automatic rejection of everyone of the disliked racial group is racism.

      It’s just that everyone has the right to those prejudices in some circumstances (but not in all circumstances.)

      If it is crucial within any circumstance that the person actually LIKE someone, there is no use legislating that they must receive the services in spite of their dislike.

      An OB-GYN exam is not the same as handing over a cup of coffee in a diner, or processing applications without sorting by racial group.

      So whether it is a racist or gender prejudice or just a “preference,” patients have every right to act on their feelings, no matter who disapproves.
      It is the patients’ perfect right even if it hinders a “diverse workforce.”

    • That’s right, Sam.

      It makes sense to require that decisions of economic value be not racist, sexist, and so on — but only when the transactions are between people who are “generic” and interchangeable.

      A patron at a diner, a student in a school — these are generic interactions, performed the same for everyone and anyone by anyone.

      One waitress has exactly the same function as any other, and one customer is just interchangeable with all the other customers.

      It is when it is a personal and specific service for a specific individual that people can have preferences and even prejudices. (We have to accept prejudices in certain cases or else unleash the horrors of “Thought Policing” on ourselves.)

      So a baker makes dozens of donuts to be sold indiscriminately to any customer who asks.

      But then confusion and controversy arise when the baker is asked to create a specially-designed artisanal cake using his own artistry, taste, judgment, skills … for a same-sex wedding.

      Is this just a generic service available to any member of the general public, or is it an intimate and personal one?

      (sigh) These are consensus views that take a long time for society to settle down with as conventional practices that solve most problems most of the time. We have a way to go.

  • Because of the highly intimate nature of marriage, we expect marriage partners to be selected within racial, religious, and gender demographics. No one condemns a white Baptist woman who will not consider marriage to an African-American Muslim female, but who instead dates only white Christian males.

    Even if the African-American Muslim female thinks that the white Christian woman’s preferences cheat her somehow, that is not a problem that a bride can be charged with solving.

    Like marriage, the patient-physician relationship is also an extremely intimate one — psychologically and physically.

    It must be respected as entirely natural that women (and men) are finicky and selective about those whose fingers they allow to probe inside the mouth, vagina and anus, and with whom they will have some of the most intimate conversations, and with whom they will make some of the most personal and high-stakes decisions of their lives.

    Whatever eases this relationship and the intimacy and trust that a good doctor-patient outcome requires is something we have to simply tolerate.

    No patient should be reprimanded, pressured, or lectured about “creating a diverse workforce” into accepting a physician they are uncomfortable with.
    It is a reasonable position that does not depend for its legitimacy on the personal opinions or the judgment of others.

    It is hard to imagine a nation in which patients are forced to undergo these intensely personal and intimate experiences with a doctor who makes them cringe.

    Patients, like marriage partners, are (and should be) entirely free to be highly selective about the people they are willing to enter into this relationship with — no matter who doesn’t approve. It is entirely unreasonable and undesirable that they be forced make these choices in order to balance the national sociological agendas of diversity advocates.

    That is bad for patients — and it’s not really good for doctors either to have to cope with resentful, distrustful patients who dislike them and don’t want them as the doctor.

    It is unfair to demand that people undergoing medical treatments also must sacrifice their feelings and attitudes in order to advance the social aspirations of someone else.

    Patients cannot be used as sociological lab animals, with the costs of adjusting the nation’s bad attitudes forced onto them.

  • Because of its highly intimate nature, we expect marriage partners to be selected within racial, religious, and gender demographics. No one condemns a white Baptist woman who will not consider marriage to an African-American Muslim female, but who instead dates only white Christian males.

    Even if the African-American Muslim female thinks that the white Christian woman’s preferences cheat her somehow, that is not a problem that a bride can be charged with solving.

    Like marriage, the patient-physician relationship is also an extremely intimate one — psychologically and physically.

    It must be respected as entirely natural that women (and men) are finicky and selective about those whose fingers they allow to probe inside the mouth, vagina and anus, and with whom they will have some of the most intimate conversations, and with whom they will make some of the most personal and high-stakes decisions of their lives.

    Whatever eases this relationship and the intimacy and trust that a good doctor-patient outcome requires is something we have to simply tolerate.

    No patient should be reprimanded, pressured, or lectured about “creating a diverse workforce” into accepting a physician they are uncomfortable with.
    It is a reasonable position that does not depend for its legitimacy on the personal opinions or the judgment of others.

    It is hard to imagine a nation in which patients are forced to undergo these intensely personal and intimate experiences with a doctor who makes them cringe.

    Patients, like marriage partners, are (and should be) entirely free to be highly selective about the people they are willing to enter into this relationship with — no matter who doesn’t approve. It is entirely unreasonable and undesirable that they be forced make these choices in order to balance the national sociological agendas of diversity advocates.

    That is bad for patients — and it’s not really good for doctors either to have to cope with resentful, distrustful patients who dislike them and don’t want them as the doctor.

    It is unfair to demand that people undergoing medical treatments also must sacrifice their feelings and attitudes in order to advance the social aspirations of someone else.

    Patients cannot be used as sociological lab animals, with the costs of adjusting the nation’s bad attitudes forced onto them.

    • As a Muslim, I completely agree with this comment. This article seems to imply that healthcare is NOT a service industry that serves the needs of the patient – that somehow, patients don’t have a right to decide the factors that comprise their care. It’s one thing to say that patients can’t choose which procedures are best for their medical conditions, which are dictated by scientific evidence and the doctor’s expert opinion. It’s an entirely different thing to say that patients shouldn’t be able to choose the social factors that comprise their care, of which there is no better expert for choosing what is best than the patients themselves. The views in this article resemble the dangerous thinking of predominantly left-leaning people who believe themselves morally superior to others and able to infringe on others’ freedoms in the pursuit of their own personal vision of “justice.”

      I think what the author is promoting is the sort of thing that can happen when healthcare becomes a “right” that patients are entitled to – doctors and hospitals will be able to dictate the social options, and even medical options, that patients have, and if someone is uncomfortable with a black Muslim doctor, they will simply be told, “Well, suck it up because this is what you’re getting.”

      People have a right to make their own decisions, even if they are misinformed, just like the author has the right to present his unethical opinion as if it promotes some sort of social good. What we really need is to ensure that patients can continue to have their basic liberties safeguarded from poor policy choices like those promoted here.

    • @Zane

      This is a self-serving opinion piece.

      If patients don’t want this doctor to treat them for whatever reason, she wants the bad patients to be denounced by all the other doctors and forced to accept her.

  • You can blame diversity quotas in college admissions and diversity hiring practices for why we dont want to see an unqualified doctor. Standards are racist.

    • Practicing, licensed physicians, by definition, are not “unqualified.” Diversity makes the profession better.

    • I’ll take the over-achieving person of color or woman who worked twice as hard to get their degrees over the privileged white male whose parents had to bribe their unqualified child’s way into school. Unfounded prejudice or accurate social commentary?

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