Post by Spencer Willette
From your workstation during the middle of a busy shift, you overhear a nurse triaging a patient who is here for a reasonable complaint. You tune out until suddenly you hear the patient degrading the nurse based on their race. The term “if you ain’t from America or white, I don’t want you involved in my care”. The nurse (being seasoned) tries to diffuse the situation, but the patient escalates the exchange with expletives, sexists comments, racial slurs, etc.
How do you intervene?
Set the tone with the patient and support your staff. Words matter. Inappropriate language in general is not acceptable but especially when it is directed towards health care workers. Lay out expectations and rules for engagement regarding their clinical encounter that certain language and behaviors will not be tolerated. If this patient wants to seek medical care from this department then these are the guidelines for how they need to behave. A patient’s derogatory language and belittling of a staff member calls for an intervention.
An “ism” is an attitude or belief that oftentimes involve preconceived notions towards an individual or group based upon certain characteristics. Examples include racism, sexism, ageism, and other forms of oppression.
If a staff member displays “isms” towards a patient, this also calls for an intervention. Mediation of the situation can be accomplished through pulling the staff member aside within the same shift and having a direct, honest conversation of what was witnessed. Most of the time, helping someone identify where they missed the mark will correct their future behaviors. These can be unsettling conversations, but what is necessary is not always easy.
At what point do you comply with a patient requesting a different provider for inappropriate reasons?
It can largely depend on the situation. Using the discussed scenario, if a patient is still not complying with the no-tolerance policy and is requesting a different provider in terms of sexism, racism and xenophobism, we can find it easy to accommodate their wishes. Not that it’s the right thing to do, but it depends if you want to have your nurse be continually belittled throughout the entirety of the patient’s stay. Have a discussion with the nurse and understand their perspective if they are uncomfortable caring for the patient.
Additionally, we’ve all been in the situation where a patient is requesting to see the attending physician instead of multiple levels of trainees (the medical students and residents). Again, it is beneficial to be direct with the patient and tell them that they chose to come to a teaching hospital and this is how our department functions. Supporting your students and staff is imperative for their education and working environment. There is a lot of ambiguity in these scenarios making it challenging to do what’s right for both your staff’s wellbeing and the patient’s care.
How do we apply these lessons to our current practice environment?
This topic is of particular concern in our current social and political environment. In May, as we were fully realizing the depths of the COVID pandemic, the< AMA felt the need to post a warning against xenophobia and racism.
AAMC. 2020. Racism And Health: A Reading List. [online] Available at: <https://www.aamc.org/news-insights/racism-and-health-reading-list<> [Accessed 21 November 2020].
Communication Theory. 2020. The Johari Window Model. [online] Available at: <https://www.communicationtheory.org/the-johari-window-model/> [Accessed 21 November 2020].
Garran, A. and Rasmussen, B., 2020. How Should Organizations Respond To Racism Against Health Care Workers?. [online] Journal of Ethics | American Medical Association. Available at: <https://journalofethics.ama-assn.org/article/how-should-organizations-respond-racism-against-health-care-workers/2019-06> [Accessed 21 November 2020].
Monique Tello, M., 2020. Racism And Discrimination In Health Care: Providers And Patients – Harvard Health Blog. [online] Harvard Health Blog. Available at: <https://www.health.harvard.edu/blog/racism-discrimination-health-care-providers-patients-2017011611015> [Accessed 21 November 2020].
New England Journal of Medicine. 2020. Diagnosing And Treating Systemic Racism | NEJM. [online] Available at: <https://www.nejm.org/doi/full/10.1056/NEJMe2021693> [Accessed 21 November 2020].
Physiciansweekly.com. 2020. Gender Bias Narratives In Medicine | Physician’s Weekly. [online] Available at: <https://www.physiciansweekly.com/gender-bias-narratives-in-medicine/> [Accessed 21 November 2020].
Yasmeen Serhan, T., 2020. The Other Problematic Outbreak. [online] The Atlantic. Available at: <https://www.theatlantic.com/international/archive/2020/03/coronavirus-covid19-xenophobia-racism/607816/> [Accessed 21 November 2020].
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