Racism in Medicine: An “Open Secret” as originally seen on CNN.
We’ve discussed bias medical professionals may have toward their patients, but what about the flip side? What about when a patient has an unwarranted bias against their caregiver?
First of all, what does that look like coming from a patient? The article mentions several examples of a race bias which sound like, “I don’t want a Jewish doctor,” or “I don’t want any black people working with my baby” or the muttered, “Stupid, gringa [derogatory term for white person]” that I’ve heard behind my back before. I’ve mentioned my personal experiences with sexism before. These sound like, “You can’t lift me! I’m too heavy for you. Go get a man,” or “[Wolf whistle.] Can you turn around and walk your sexy ass back out of the room again for me?” (I still don’t understand how anyone can think scrubs are sexy in the slightest.) I’ve also experienced ageism on the job. That sounds like, “Are you sure you know what you’re doing? How long have you been working here?” Or on the flip side, some of my older coworkers have mentioned hearing, “Haven’t you retired yet?” I’ve heard from patients regarding one of our physicians, “I thought he was dead! I haven’t seen him in 30 years!”
So what’s a medical professional to do? Remember what you are: a PROFESSIONAL. Professionals do NOT engage the patient; however, professionals (nor anyone else for that matter) is required to be a door mat and just “take it.” Our payment system is quickly being ushered into a new era of pay for quality, instead of the pay for quantity we currently. Which is all well and good, but when the receivers of our services have unwarranted biases against their medical professionals, the perceived value aka quality of the provided services will decrease, as mentioned in the article. So we are financially incentivized to bow and scrape to every whim of the patient, no matter how ridiculous. Which is also how we get 5,000 x-rays for ingrown toe nails and opioid epidemics, but that’s a different story all together.
According to the article, the American Medical Association recommends that when a patient has disruptive behavior to “‘terminate the patient-[professional] relationship with a patient who uses derogatory language or acts in prejudicial manner only if the patient will not modify the conduct. In such cases the [medical professional] should arrange to transfer the patient’s care.'” Also according to the article, 40% of physicians are reporting having experienced some sort of racial bias against themselves on the job. Add in the other biases, and personally, I would say I experience some sort of unwarranted bias at least once each week or at least two. And if that’s my experience, I can only imagine how much flack others of more marginalized groups such as the black, native American, middle eastern, LGBT groups get on the job. (Not shooting for a poor little white girl piece here.) So practically, I can’t ask to be removed from EVERY patient case in which the patient or the family have made me feel uncomfortable. My supervisor would get completely annoyed with me.
So this is what I do. I keep my mouth shut. I try to accommodate their requests and/or answer their questions as best I can and actively demonstrate why I indeed am qualified to do what I do. For example, the “You can’t lift me!” always comes on evaluation day, when I have to personally feel what a patient can and can’t do in order to perform my assessment. So I’ll go recruit some poor male coworker (who has to leave his patient to deal with this ridiculous request, thereby jeopardizing that patient’s experience and perceived quality of care). I’ll explain to him the plan and get to work. He stands in front of the patient (so the patient only sees the male as the one in charge of the lift), not actually assisting at all and I stand behind the patient. I do all the lifting, unless I nod my head (the pre-arranged signal) signifying this person really does need the assistance of 2 people to stand. Or for another example on age, I will tell them how long I have been working as a BOARD CERTIFIED SPECIALIST DOCTOR of physical therapy. (Including the emphasis.) I also happen to have a streak of white hair that can only been seen when I wear my hair certain ways, so on days I know I’ll be meeting a patient’ s family, I’ll wear my hair where that streak shows. That way I look older. Or if I don’t look like the patient or family’s idea of an authority figure, for whatever bias they may have, I will send in a “mouthpiece” to do my talking or instructing for me. Whether they won’t believe me or do what I say because I’m a woman or because I’m younger or because I don’t have the same color skin (in that moment, because what race accepts me as their own depends on how much sun I’ve gotten recently), I’ll send someone they will respond more appropriately to in order to discuss or instruct what I intended to do myself.
But if the attacks are subtle, like “accidently” putting a head or hand on my chest in a transfer, I’ll give a “stink eye” and a word of warning jokingly the first time around. If it happens again, that’s when I’ll ask to be taken off the case. Again, as a professional, I do not escalate the situation, but I also don’t have to be bullied.
What have been your experiences with bias against yourself on the job? How did you handle it? Would you recommend that particular method? I want to hear from you!