by: Alex Smith, @alexsmithMD
I'd like GeriPal reader's help with an issue that has vexed me since medical school.
As a third year medical student, I cared for an elderly patient in a residential hospice facility with advanced cancer. Unable to get up and about without assistance, he complained about feeling "trapped" in his room. So I got him into the wheelchair and we went outside to enjoy the California sun.
Several nurses passed by on the other side of the street and my patient made horrible racist remarks about them.
I froze.
I didn't know what to do. I felt terrible that he was saying these things about the nurses. I was also aware that the nurses could not hear him - we were too far away - and that this man was nearing the end of his life. Nothing I said was likely to change his perspective or his behavior. I said nothing. He died two weeks later. I've felt bad about that lack of response ever since.
I'd like to write a piece about a better way to approach the racist patient. While there have been provocative stories in the literature (also here and here), there has been little written in the way of a well thought-out approach to the racist patient. My early sense is that there is almost always more going on than the racism: PTSD, feeling ignored, pain. We should explore and respond to the underlying issues first. That can be hard. Racism pushes buttons like few other issues.
I can use your help. I'm looking for stories about racist patients you have cared for in geriatrics and palliative care. My sense is racism is more common in geriatrics and palliative care because (1) our patients are older, and lived in a time before Civil Rights; and (2) racist comments may be an expression of vulnerability and distress.
Racism runs a spectrum, from a Jewish provider and a patient with an antisemitic tattoo, to comments directed at other members of the healthcare team (as in my story above), to comments directed at the provider. I'm interested in all of these stories. Please respond with stories in the comments.
Some rules:
(1) Keep it anonymous. Notice how you couldn't identify the patient in my story, but the essence of the story came across? Some tricks - change the gender, the setting, the disease, the relationship of the caregiver.
(2) Stories are most helpful if you share how you responded and why.
A final thought. I want to write a paper about how physicians should approach the racist patient. But my sense is that, despite the influx of foreign medical graduates and increasing diversity of the physician workforce, racist comments directed at non-physician members of the health care team are far more common than comments directed at physicians. Nurses. Nurses assistants. I just returned from our nursing home where the nurses and nurses aids related story after story of racist patients. In our hospital, there is far more diversity among the nurses assistants than the physicians. They are turning patients, responding to call buttons, asking about pain. Patients may be reluctant to make the same racist remarks to a physician due to social norms.
What is the physician's obligation to respond when the racism is directed at other members of the healthcare team? How should physicians respond when a patient asks not to be cared for by minority providers?
I'd like GeriPal reader's help with an issue that has vexed me since medical school.
As a third year medical student, I cared for an elderly patient in a residential hospice facility with advanced cancer. Unable to get up and about without assistance, he complained about feeling "trapped" in his room. So I got him into the wheelchair and we went outside to enjoy the California sun.
Several nurses passed by on the other side of the street and my patient made horrible racist remarks about them.
I froze.
I didn't know what to do. I felt terrible that he was saying these things about the nurses. I was also aware that the nurses could not hear him - we were too far away - and that this man was nearing the end of his life. Nothing I said was likely to change his perspective or his behavior. I said nothing. He died two weeks later. I've felt bad about that lack of response ever since.
I'd like to write a piece about a better way to approach the racist patient. While there have been provocative stories in the literature (also here and here), there has been little written in the way of a well thought-out approach to the racist patient. My early sense is that there is almost always more going on than the racism: PTSD, feeling ignored, pain. We should explore and respond to the underlying issues first. That can be hard. Racism pushes buttons like few other issues.
I can use your help. I'm looking for stories about racist patients you have cared for in geriatrics and palliative care. My sense is racism is more common in geriatrics and palliative care because (1) our patients are older, and lived in a time before Civil Rights; and (2) racist comments may be an expression of vulnerability and distress.
Racism runs a spectrum, from a Jewish provider and a patient with an antisemitic tattoo, to comments directed at other members of the healthcare team (as in my story above), to comments directed at the provider. I'm interested in all of these stories. Please respond with stories in the comments.
Some rules:
(1) Keep it anonymous. Notice how you couldn't identify the patient in my story, but the essence of the story came across? Some tricks - change the gender, the setting, the disease, the relationship of the caregiver.
(2) Stories are most helpful if you share how you responded and why.
A final thought. I want to write a paper about how physicians should approach the racist patient. But my sense is that, despite the influx of foreign medical graduates and increasing diversity of the physician workforce, racist comments directed at non-physician members of the health care team are far more common than comments directed at physicians. Nurses. Nurses assistants. I just returned from our nursing home where the nurses and nurses aids related story after story of racist patients. In our hospital, there is far more diversity among the nurses assistants than the physicians. They are turning patients, responding to call buttons, asking about pain. Patients may be reluctant to make the same racist remarks to a physician due to social norms.
What is the physician's obligation to respond when the racism is directed at other members of the healthcare team? How should physicians respond when a patient asks not to be cared for by minority providers?
Comments
There was a patient in my hospital who was very racist towards another color of people. Two different nurses reacted in two different ways. One nurse requested an exchange of patients in order to continue to provide best care which this situation she felt was compromising for her. Another nurse experiencing the same racist comments felt that she could provide best care practices even though these comments were being made and she made the decision to continue working with this patient. Both understood that a patient's rights culturally needed to be protected as well as their own physical and emotional safety. As a support person for the nurses and the patient. I listened to concerns on both sides and continued to watch for emotional health. I didn't encourage the patient's words. I just listened and provided the patient the opportunity to have a right to her own cultural understanding while also giving the caregivers time to speak with me about the difficulties they were having. They both understood that I could not correct the patient's words and that I didn't believe those words. In that case I knew that I did the best care possible to both the patient and the caregivers.
The lesson I learned is that people may denigrate or lash out at others because they are scared or unsure of themselves. The "other" may be frightening to some people and I now challenge racist comments as non-judgmentally as possible. I say something to the effect that I have NOT found "all blacks to be ignorant, all whites to be superficial, etc". It may not change the mind of the person making the comments but I feel better for clarifying that I have had a different experience.
Hospital delirium causes hallucinations, and many of those involve the staff that surround them, which are often ethnic. I think some of this feeds their remarks. Once they recover from that delirium, they still believe that parts of that are real. My dad, even years later, cannot be convinced that his hallucinations were not real.
During my mom's last visit (she does have dementia), she made several comments about a physical feature of the face that my mom wanted to touch, much like a child.
I work with large numbers of under-represented youths. I think a lot about issues that they face and the attitudes of others around them. I think it's up to each of us, when these things are said, to address them. Sometimes you don't have to say much, even if it's just to say that you disagree. But I think it's wrong to say nothing.
I think many of the more subtle remarks are more difficult. I don't know where my mom's fascination with the nurse's face came from, unless it was because she was different, and when you feel you have nothing at the time, maybe it's easier to concentrate on what's different.
As these comments remind us, this issue is remarkably complex, and there is no single answer for all situations.
http://www.gradydoctor.com/2011/12/sos.html
My name is Jennifer Webster and I write for MD News, a magazine for physicians and healthcare executives (www.mdnews.com). I'm working on an article about how physicians and others caregivers deal with patients who are openly racist towards their providers.
If anyone here would care to comment on this topic, from the position of a doctor, nurse, or healthcare administrator, please drop me an email: jwebster (at) truenorthcustom.com.
Thank you so much!