COMMENTARY

Racist Patients in Medical Training: How to Respond

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

Disclosures

May 14, 2019

What to Do When Confronted With a Racist Patient

Thankfully, some have recognized the need for further dialogue and work in this area. In 2016, Paul-Emile and colleagues published a framework for how to respond to racist patients. The authors suggest key ethical and practical considerations, including the following:

  • First, determine the patient's medical condition and stability. If the patient is unstable, they should be treated immediately.

  • Stable patients should be assessed for decision-making capacity. If a patient lacks decision-making capacity, Paul-Emile and colleagues recommend "negotiation and persuasion," ideally in collaboration with the patient's family, to garner cooperation to receive care. The authors also suggest that patients with significant cognitive impairment are generally not held to be "ethically responsible."

  • If the patient does have decision-making capacity, consider the underlying motivations for his/her discriminatory behavior. As the authors describe, "Requests for an ethnically or a racially concordant physician may be ethically appropriate in certain cases—for instance, for reasons of religion or culture (eg, Muslim women requesting female clinicians) or of language." They further clarify that patients who belong to certain minority groups may seek physicians from those same groups, probably because of a history of discrimination or other experiences that have promoted mistrust within them. In these settings, accommodating the patient's request is reasonable.

  • If a patient's racially motivated request does in fact stem from bigotry, the authors suggest that healthcare providers discuss the options for patient care with their team and consider how the patient-provider interaction will affect the provider.

Responses can vary, depending on the nature of the racist behavior and the context in which it is applied; however, trainees should feel empowered to set limits with patients and have the support of their supervisors to transfer that patient if appropriate.

Conferences should also be made available for trainees that educate on how to recognize racially motivated behaviors and comments, as well as best practices on how to respond. Likewise, cultivating and financially supporting diversity groups among trainees is crucial for mitigating the effect of dealing with racist patients. Communities offer healing, and diversity groups help provide a platform for those who have had these experiences to share in a safe space. Finally, further research must be conducted on the extent of racist patient behaviors to better inform effective institutional policies.

We know that racist patients are an undeniable reality and that the particular veracity of hateful rhetoric playing across television screens and on social media is also making its way into exam rooms. Each of us has a role in ensuring that our most vulnerable providers are able to reach their full potential in an environment in which they are valued and respected.

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