When Patients Discriminate Against Doctors: A Muslim Physician Weighs In

Seema Yasmin, MD


April 14, 2017

Seeking Guidance

That's not unusual. Although many doctors face discrimination—a 2015 study of Stanford University pediatric residents[1] found that 15% experienced or witnessed discrimination from a patient or a patient's family—there are no clear guidelines on how to respond.

The American Medical Association's code of medical ethics does not specifically address racist, sexist patients demanding white, male doctors. Instead, the code speaks broadly to "disruptive behavior by patients."

That's shortsighted. About 280,000 doctors in the United States are international medical graduates, according to the American Medical Association. That's 1 in 4 doctors. After President Trump's first iteration of the Muslim ban in January, I interviewed some of those affected by the new policy for articles that appeared in Scientific American[2] and the Dallas Morning News.[3]

Racist interactions were part of being a doctor in the West, they told me. Just another professional hazard, like needle-stick injuries and deranged sleep cycles. Racist patients and the shame and degradation they incited were not to be discussed. You shrug off the ignominy of being referred to as "you people" during the ward round because medical school teaches and residency reaffirms that the patient—even the racist one—always comes first.

In a 2016 New England Journal of Medicine article titled "Dealing with Racist Patients,"[4] the authors wrote that "competent patients have the right to refuse medical care..." and "employees of health care institutions have the right to a workplace free from discrimination based on race, color, religion, sex, and national origin...."

The authors offer a framework for dealing with such patients as Mrs Smith, which begins with determining whether the patient is stable or unstable and assessing their capacity to make a decision. For me, that meant evaluating Mrs Smith's pallor, respiratory rate, oxygen saturation, and use of accessory muscles, among other things, as she told me she would not be touched by a brown woman.

An Uncertain Path Forward

In the past year, I've watched as that kind of anti-woman, anti-foreigner, anti-Muslim vitriol has flourished. It's a platform exploited by the man who holds the highest office in the land, a man who has emboldened racists to spew their racism.

On the day the presidential election results were announced in November, I was teaching epidemiology to a class of mostly premed students at the University of Texas at Dallas. Some of my students cried so hard, fearing for their safety and dignity, that they had to be excused from class.

They will meet many Mrs Smiths. Patients whose blood fizzes with carbon dioxide, their shoulders hunched, hands gripped around the edge of an examination table, intercostal muscles retracted against the strain of stiff lungs. Patients who will use what precious oxygen floats in those rigid lungs to say, "I don't like your kind. I want a white doctor. A man." And we brown women will care for them as best we can, because that is what we do.

That night in 2010 when I was an intern, I actually walked through half a dozen wards looking for a white doctor for Mrs Smith. It was a futile pursuit in an East London hospital. Eventually, I found a young man, a fellow intern who was Indian, and I briefed him on the interaction and the need for an arterial blood gas measurement.

He followed me back to the ward, where I had assembled the apparatus needed for the test. He picked a thicker needle than the one I would have used and entered Mrs Smith's room. I heard some mumbled talking and then a groan, presumably at the point where his needle penetrated an artery in Mrs Smith's wrist.

Then my bleeper buzzed. A patient was in cardiac arrest and I ran through the hospital, shoving my shame and my relief into blue latex gloves, and never mentioning again what had happened.


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