Page 10 - Delaware Medical Journal - October 2017
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PRESIDENT’S PAGE
There has been literature published on
how health care professionals should approach patients extolling racist or bigoted comments or requests. In 2016, The New England Journal of Medicine (NEJM) published a perspective piece entitled “Dealing with Racist Patients” which consider a patient’s request for physician reassignment based on race or ethnic background in an emergency setting.1
The key decision point in this algorithm focuses on patient stability. If the patient
is stable and competent, a physician may elect to engage
the patient in conversation about why he or she holds such beliefs. If
it becomes clear that the patient’s statements come from a place of bigotry, then the patient should be told that
his behavior is unacceptable.
The situation can become much more complex with unstable patients. The NEJM algorithm suggests proceeding with care and treatment. This may be easier said than done. A different approach published in the American Journal of Orthopedics suggests that if another physician can easily and
immediately provide emergent treatment without compromising care to other sick individuals then “the patient’s wishes should be honored and attempts should be made to receive permission for life-saving or limb-saving intervention. If the patient’s wishes cannot be respected in a life-or- death scenario and the patient continues
to refuse care, the principle of patient autonomy dictates that no care can be provided. Much in the same way Jehovah’s Witnesses can refuse transfusion of blood products based upon their belief system, any patient can and should be allowed to
2 If a patient is ultimately provided a different doctor, he or she “should be informed that 1
There may be situations in which a patient’s request for a physician of a certain ethnic background may be considered acceptable. There is data to support the relationships. A 1999 Journal of the American Medical Association (JAMA) article study concluded “patients seeing physicians of their own race rate their physicians’ decision-making styles as more participatory.”3
While we commit ourselves to providing the best medical care to patients regardless of race, it is unfortunate that we may be the recipients of hateful
or derogatory speech. Yet, we must remember that our interactions with patients are far more positive than negative. I would hope that we physicians support one another when we do see racist behavior towards our colleagues. It is simply not acceptable.
Prayus Tailor, M.D.
President, Medical Society of Delaware
REFERENCES
1. Kimani P, Smith AK, Lo B, Fernández A. Dealing with racist patients. N Engl J Med. 2016;374:708-711.
2. Singh K, Sivasubramaniam P, Ghuman S, Mir H. The dilemma of the racist patient. Am J Orthop. 2015;44:E477-E479.
3. Cooper-Patrick L, Gallo JJ, Gonzales JJ, et al. Race, gender and partnership in the patient-physician relationship. JAMA. 1999;282:583-589.
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