According to a case study published in the AMA Journal of Ethics, affect labeling, putting feelings into words, is a strategy that should be taught to clinicians to help them cope with expressions of racism by patients.
The case involved Mr K, a 75-year-old patient who carried a Confederate flag handkerchief and had a faded Aryan fist tattoo on his arm. After falling at home, Mr K was admitted to the emergency department of a teaching hospital and was treated by SM, a fourth-year, African American medical student. SM examined Mr K, initiating the interview by asking, “Mr K, can you tell me where you are?” Mr K responded, “The ‘hood!” SM had intended to rock Mr K’s shoulder to check his consciousness but decided not to touch him for fear of his response. The attending physician noted Mr K’s racist symbolism and wondered how to mediate the situation.
Although a physician’s duty is to provide first-rate care for all patients, the investigator suggests that reactions to racism are often visceral rather than intellectual, and that affect labeling is a coping strategy that can help clinicians process and overcome their instinctive response. In this case, the investigator noted that the attending physician could have intervened to help SM process his feelings by providing affect labels such as shocked, upset, hurt, sad, confused, or angry. The act of articulating an experience can modulate emotional, neural, autonomic, and behavioral responses.
In the case of Mr K, if he were considered stable, the attending physician could help him connect emotions to his experience: “How does it make you feel when SM is in the room? How do you feel when I tell you that SM is one of our top physicians and is capable of providing you excellent care?” Ideally, to foster learning and trust, the investigator recommends having a subsequent conversation that includes all involved parties. Health care organizations can facilitate affect labeling by teaching their staff how to respond and by using exercises such as expressive writing to equip medical students and residents with affect labels.
Affect labeling should be taught to all clinicians to give them a tool they can use to ameliorate their responses to racist expressions by patients and to further help them mediate discussions between other clinicians and patients or between clinicians and other staff.
Mitchell CD. How should clinicians and trainees respond to each other and to patients whose views or behaviors are offensive? AMA J Ethics. 2019;21(6):e480-e484.