“Isms” – Part 2” with our hosts Andy Little, DO and Drew Kalnow, DO with guest host John Casey, DO; and guests George Willis, MD; and Tarlan Hedayati, MD.


Post by Patricia Capone, OMS III

While on shift, you’re charting and all of a sudden you hear this belligerent patient being wheeled to your side. As the patient is being wheeled in by one of the techs, you hear the patient make some inappropriate comments towards the tech.The patient is then roomed and triaged by the nurse. Despite the nurse being very polite, the patient continues to spout off awful comments that promote racism, sexism, ageism, etc. You, as the physician, get up and  decide to head towards the patient’s room to assess the situation.

How do you handle the situation?

Is the patient sick or not sick?

  • Sick?
    • If the patient appears urgently or emergently sick, you do whatever you have to do to get that patient stable, even if that means sedating the patient or asking a different physician to see the patient because the patient is uncomfortable with having you as their doctor.
  • Not sick?
      • If the patient is not urgently or emergently sick, try to figure out the safest and most appropriate way to get the patient discharged by setting rules of engagement.
        • If the patient is exhibiting this behavior to other staff, nurses, residents or students be sure to have a quick conversation with them, reassure them that you are in their corner and invite them to work with you to develop a plan for getting this patient discharged safely.



Set the rules of engagement:

      • Inform the patient that certain behaviors will not be tolerated.
      • Explain to the patient that you understand that they are sick and that you are here to take care of them, but in order to do that they must act appropriately and allow us to do our jobs.
      • Remind the patient that they have the option to leave at any time.


Check yourself before you wreck yourself:

      • Always remember that in Emergency Medicine, we have the privilege of providing care to patients on their worst days, so the person that is coming in acting this way may be doing so out of fear or anxiety. While this is not an excuse, often patients just need to be told that your goal is to help them.
      • In certain circumstances, patients may have legitimate reasons for wanting a different doctor that are not based in prejudice. It may be a decision based on religious preferences or a result of past negative experiences.


How do we educate residents and others in an attempt to tackle these isms and similar systemic problems?

      • Help them to identify and understand their our own implicit biases
      • Lead by example and show them how to take care of patients who come in and subject the whole staff to any particular ism.
      • Teach them to look past the baggage that patients come to the ED with and do what’s best for the patient.
      • Have conversations in the moment that help them to grow
      • Teach them to avoid looking at the patient’s history prior to speaking with the patient and making prejudgments about why the patient presented to the ED that day.
        • Making prejudgements can sometimes cloud your ability to keep your differential broad, so just focus on the facts in that moment.
      • Encourage them to work on their biases on shift, as well as, off shift.




About our Guests: Dr. George Willis, MD is the Assistant Program Director at University of Maryland. Dr. Tarlan Hedayati, MD is the Associate Program Director of Cook County Emergency Medicine.


Looking For More?

More on Tackling Isms: Check out a few of our other episodes like  “Episode 95: Isms Part 1”, Clinical Grind 10: #Bias, Episode 47: Fundamental Attribution Error, Discussing Normal.

More from Andy, Tanner, and Drew: Be sure to subscribe to our new newsletter for more information about what the team is reading, listening to and so much more!


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Episode 96 Isms Part 2

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