August 22, 2017

'Bigotry in a hospital gown': How doctors handle racism from patients

Daily Briefing

    Doctors say they routinely face racism and bigotry while caring for patients, and after the white supremacist protest in Charlottesville, Virginia, many are speaking out about their experiences—including one physician whose "chilling" tweet thread went viral last week.

    How to address health inequity in your community

    A physician's experience goes viral

    Esther Choo, an emergency physician and associate professor at Oregon Health & Science University in Portland, on Sunday took to Twitter to share her experiences with racism in the ED. "We've got a lot of white nationalists in Oregon," she posted in the first of several tweets. "So a few times a year, a patient in the [ED] refuses treatment from me because of my race." 

    In such situations, Choo wrote that she tells the patient, "I understand your viewpoint. I trained at elite institutions & have been practicing for 15 years. You are welcome to refuse care ... under my hands, but I feel confident that I am the most qualified to care for you. Especially since the alternative is an intern." Invariably, she adds, the patient will leave or pick the intern—so long as the intern is white.

    Despite the bigotry, Choo wrote that she doesn't "get angry or upset" when this happens—"just incredulous over the psychology of it." But she added, "You know what gives me hope? ...  A few get uncomfortable and apologize in the same breath they refuse to let me treat them. You see ... It's a hell of a hard thing to maintain that level of hate face-to-face."

    She concluded:

    Her tweet and responses went viral, with over 24,000 retweets and over 45,000 likes.

    How other doctors handle the issue

    Choo is one of many physicians who have shared their experiences with racism in the wake of the Charlottesville protest.

    For instance, writing for STAT News, Jennifer Okwerekwu, a second-year psychiatry resident, discussed the "quiet racism" she encountered treating patients while a medical student at the University of Virginia. Citing her experiences with patients who refused to look at her on account of her race, or who dismissed her medical education, Okwerekwu wrote, "This is the America I know, the medicine I know. Bigotry in a hospital gown—it's a risk I face every day when I go into work."

    But Okwerekwu also described how her coworkers have supported and protected her, including a nurse who reminded one patient that Okwerekwu "deserved … respect" and an attending who corrected a patient's incorrect, racist assumptions about Okwerekwu.

    "This is the America I want. The medicine I aspire to," she wrote. "In this medicine, I don't have to shoulder the injustice of racism alone. My role as a doctor doesn't negate my humanity. My coworkers and I form a team [who] supports one another."

    Separately, writing in NPR's "Shots," John Schumann, an internal medicine doctor and president of the University of Oklahoma's Tulsa campus, acknowledged the challenges of treating patients with hateful beliefs—but that it is a physician's responsibility to care for his or her patients regardless. 

    Citing old and new research, Schumann recommended multiple strategies to carry out this clear obligation, such as identifying, accepting, and moving past the "dread" of treating such patients or using a "decision tree" featured in the New England Journal of Medicine to ascertain when it's "appropriate to accommodate a bigoted patient's request to find another doctor."

    Ultimately, however, Schumann cited Choo's determination to "make sure [patients'] hate finds no purchase here" (Gutierrez, Sacramento Bee, 8/16; Okwerekwu, STAT News, 8/14; Schumann, "Shots," NPR,  8/16).

    How to address health inequity in your community

    With the shift in health care to focus on optimizing the health of individuals and communities, health care organizations are creating new strategies to address health care disparities in access and patient outcomes.

    Advisory Board has created the Health Disparities Initiative, which provides actionable resources on a series of strategic imperatives and special topics to achieve equity of care. Interested in seeing research or resources that address your biggest health equity problems?

    Download our resource, "Building Community Partnerships to Reduce Disparities," which includes studies featuring providers who have successfully partnered with community organizations to address health disparities and social determinants of health. You'll also find tools that can guide your organization’s community partnership strategy.

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