By: Gopi Astik, MD, Hospitalist, Medical Director, Northwestern Medical Hospital
I walked into a patient room one frigidly cold Chicago morning with the warmest smile on my face. I spoke to the gentleman who was admitted with an acute exacerbation of his COPD a few days prior and had improved over the weekend. He had been weaned off of oxygen the day before and appeared clinically ready for discharge. My previous colleague had mentioned the patient was quite chatty, so I was surprised he didn’t say much to me. I figured he had a case of the Mondays and went on discussing his labs, imaging and objective findings on exam. He stated he felt ready for discharge, so I sat down to discuss logistics and future planning with many one-word answers and lack of eye contact from the patient. Before getting up to leave, I asked, “Is there anything you would like to ask about or say?”
The man looked up and said, “I usually don’t talk to your kind, but you aren’t that bad.” I responded, “Ok, well let me get started on that paperwork,” and went along my way. It wasn’t until a few minutes later that what he said to me actually registered. What did he mean by ‘my kind’?
Doctors? I had my white coat on with my stethoscope wrapped around my neck and badge visible on my lapel (wink, wink, C-suite). If he didn’t speak to doctors, he was in the wrong place.
Females? I don’t think this man would have gotten very far in life by not speaking to any females, so that can’t be right. Also, he had spoken at length with my female colleague who cared for him over the weekend; that can’t be it.
Short people? Although I prefer vertically challenged or fun-size, it has been said that we shorter folk are made this way because we are closer to hell. Depending on the day, this may be correct in my case.
Then I realized, he meant my race. Does my race have anything to do with the type of doctor I am? I’ve always told people I am American since I was born and raised in the USA, but my parents are originally from India. I’ve had the “But, where are you FROM?” conversation so many times I have turned it into a game where I keep naming American cities I have lived in, much to the frustration of the other party. I know what they are asking, but I’m not from India. I grew up in a small town of Missouri where I knew people weren’t always accepting of my race and religion, so this ideology wasn’t new to me; but how do I respond when I am supposed to be caring for this patient? This issue comes up monthly for me, but I was lucky that this patient wasn’t disruptive and let me do my job of being his doctor.
But I’ve had others who wouldn’t. What am I supposed to do in that case?
There are multiple papers recognizing and quantifying discrimination in the workplace. Fnais, et al. published in a 2014 paper that 19% of trainees reported gender and race discrimination in the workplace. Although we recognize this is a problem, there isn’t as much information on what to do about it. To learn more about this topic and what we can do, I’m excited for the workshop being presented at the SHM Annual Conference, Hospital Medicine 2019, called “I Don’t Want Someone Like YOU Caring for Me: Strategies to Address Discrimination by Patients and Families.”
One presenter is Dr. Brian McGillen from Penn State who created one of the first policies related to patient/family requests to change providers due to discriminatory rationale. This policy was adopted into the patient rights policy, which says patient requests for providers based on gender, ethnicity, race or sexual orientation will not be honored. It does add that some gender requests will be evaluated on case-by-case basis due to be sensitive to cultural issues. My division has adopted a similar stance but don’t have a formal policy about this. I’m definitely interested in hearing about the formalization of this as an institutional policy at Penn State.
Another presenter, Dr. Emily Whitgob, is a pediatrician at Stanford published on this topic and will present her work to provide strategies on how to approach these situations in real-time. Her abstract from Academic Pediatrics discussed three themes including cultivating a therapeutic alliance, de-personalizing such events and maintaining a safe learning environment. After reading this, I realized that I have to remove ‘myself’ from the situation, so I don’t feel attacked. This will help foster a conversation about the plan to care for the patient.
The ground-breaking work of Drs. Whitgob and McGillen were highly publicized and mentioned in the Wall Street Journal. As a workshop, there will be discussions, vignettes and a lot of essential learning about how we can support our colleagues in the moment but also how important global policy changes are. I think this will be a well-attended lecture on Wednesday, so get there early to get a seat!
In my case, when it came time for me to revisit my ‘difficult’ patient, I took some time to myself before I walked back into that room. I reminded myself I was still his doctor and had a job to do. We discussed his medications and outpatient follow-up before he thanked me for my care. I don’t think he realized how much of an impact his one statement has had on me.
I hope this session at Hospital Medicine 2019 can help people like me cope with these issues and learn how to combat them more effectively, so they don’t weigh on us going forward.