COMMENTARY

Racist Patients in Medical Training: How to Respond

Ashley M. McMullen, MD; Coauthor: Rosalyn E. Plotzker, MD, MPH

Disclosures

May 14, 2019

Stereotype Threat

Stereotype threat is a concept judiciously discussed in academic healthcare settings. More than 20 years ago, Steele and Aronson defined this as a "socially premised psychological threat that arises when one is in a situation or doing something for which a negative stereotype about one's group applies." It triggers psychological and physiological reactions that have deleterious effects on an individual's behavior. When patients make racially demeaning comments, they are delivering on that threat in the form of structural violence inflicted at a professionally vulnerable time. The result is a feeling of disempowerment and devaluing, wounds that can be both deep and long-lasting.

As I was preparing to start medical school, my mother, a well-respected pediatric nurse for more than three decades, told me stories from her early years working in the hospital. One evening, she relived the experience of having a young child refuse her care and call her the N-word while the parents stood by silently. Even though decades had passed, I could sense the visceral impact it still had on her. It wasn't just the words that were hurtful, but the inaction on the part of those watching. Her nursing supervisor simply found someone else to care for that patient, without ever addressing the behavior.

In an ongoing qualitative study at my own institution, investigators have found that students and physicians who have encountered racism from patients report an associated emotional toll that includes exhaustion, self-doubt, and increased cynicism. At a time when physician well-being and burnout remain on the forefront of national conversation, the added burden of caring for racist patients must be taken into account for any institution that considers itself a proponent of diversity.

Trainees are often inadequately equipped with the skills necessary to directly deal with racist patients. They may also be unaware of institutional policies on handling this behavior. As a medical student, I recall having an entire curriculum centered around cultural competency and the influence of physician biases on patient well-being. Although I found this information to be incredibly valuable, I had no clue how to manage the cumulative jabs of routine microaggressions, or the resounding blows of macroaggressions, directed toward me.

If you are one of few minorities, or perhaps the only minority, on a particular team, the fear is that addressing racism may be isolating or may draw unwanted attention that can negatively influence performance evaluations. Furthermore, we often practice in an environment that prioritizes patient comfort and well-being well above those of the provider.

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