Racist patient? Here's how to manage

Physicians are meant to champion the health of all people. Consequently, racist views are antithetical to the compassionate nature of healthcare. But tragically, racism remains a monumental issue in the United States, and it plays a role in medicine, too.

As a physician, you may have felt the odious impact of racist beliefs. Chances are that you have encountered a racist patient at some point in your career. But, what is the best approach when dealing with these patients? Let’s take a look at how to cope with racist-patient interactions.

Show compassion

Taking the high road is laudable. The AAFP asked its physician bloggers about how they dealt with racist patients. One blogger said that she chose not to be offended when discriminated against. She did not dwell on baseless assertions about her merit due to her physical characteristics. Instead, she said she loved and cared for all her patients the same. 

Esther Choo, MD, an ED physician of Asian descent based in Portland, posted a series of tweets about her experiences with racism there. She noted that there are a number of white nationalists in the Portland area and occasionally she cares for a patient who is overtly racist toward her. She suggested approaching racist patients with compassion, but avoiding the vicious cycle of negative emotions that may accompany such interactions.

Here is her advice, per a tweet that was retweeted thousands of times: “You see, it’s a hell of a hard thing to maintain that level of hate face-to-face. I used to cycle through disbelief, shame, anger. Now I just show compassion and move on. I figure the best thing I can do is make sure their hate finds no purchase here.”

For more, check out this story in The Oregonian.

Reassignment requests

Publishing in The ASCO Post, Thaddeus Mason Pope, JD, PhD, professor of law at the Mitchell Hamline School of Law in Saint Paul, MN, provided guidance on what to do when a bigoted patient asks to be reassigned to another provider.

To begin with, Pope stressed that institutions should not allow for such reassignment requests to be granted. First, it hurts the morale of physicians, who find such requests degrading. Fulfilling such requests also can make clinicians feel betrayed or violated. Second, fulfilling these requests is illegal, and hospitals have been sued over accommodating them. When a hospital fulfills a discriminatory request to reassign care based on race, religion, gender, sexual orientation, or national origin, the hospital assumes the role of the discriminatory agent.

Clinicians have an important role to play as well, according to Pope. They should first tell the patient that they are unable to accommodate such requests, reinforcing to the patient that they are qualified and capable of delivering proper care. If all else fails, and the patient still wants a new provider, the clinician can suggest that the patient find alternative care.

“Although a top-down approach is inadvisable, a bottom-up approach is appropriate,” Pope wrote. “Clinicians may decide among themselves to reassign care. Instead of being motivated by a desire to satisfy a patient’s request, voluntary reassignment is motivated by the clinician’s desire to avoid the racist patient. In other words, institutions should not impose reassignment, but they should also generally accommodate it.”

Of note, if a patient uses racist vitriol, they should be told that such language is not tolerated.

Exceptions and valid requests

Some requests for the reassignment of care may appear bigoted but actually reflect ethically appropriate reasons for switching physicians. For instance, a female victim of sexual abuse may request a female physician, due to trauma. Alternatively, a Muslim female patient may request a female provider for religious reasons. Another example could be a Spanish-speaking Latino patient requesting a Latino physician who speaks Spanish. Federal nondiscrimination law accepts that in certain situations gender, national origin, and religion could play a role in the provision of health care.

Nevertheless, in emergency situations, it may be impossible to fulfill even these ethically valid requests for transfer of care. According to Pope, if a patient with an acute medical condition is incapacitated, then the physician should proceed with treatment. If the patient, however, has capacity and refuses treatment, then this refusal must be upheld. The clinician should confirm that the patient understands the possible risks of refusal of care and document accordingly.

Bottom line

Occasional encounters with racist patients are, unfortunately, an inevitability in medicine. It is best to remain compassionate and do your best to help the patient. If the patient is steadfast in refusal and wants to be reassigned, it may be a good idea to accommodate the request.