According to a case published in the AMA Journal of Ethics, patients’ racism presents an ethical problem that all healthcare staff must address. Healthcare organizations are responsible for promoting awareness and guiding institutional responses that reduce harm to clinicians of color while supporting their role as care providers.
The authors of this case study sought to evaluate the nature and scope of how an organization should respond to patients’ expressions of racism against healthcare workers, including the responsibility to train staff and enact policies that address discrimination.
The investigators explored racial discrimination against healthcare workers as exposed in a case that involved a black physician in her final year of an internal medicine residency. In this scenario, Dr. C attempted to treat a patient who made racist remarks in the midst of an examination. The attending physician, an older white man, stood by quietly during the interaction; following the examination, the discussion among clinicians did not further address the patient’s remarks.
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It is important for healthcare organizations to recognize the ethical conflict that emerges for healthcare practitioners of color: namely, that they must decide between their duty to provide care and their duty not to treat patients against their wishes, all while managing the harm done by the patient’s abuse, and, in this scenario, their mentor’s failure to address the issue. A guideline should be provided on how an institution best responds to these issues, with the aim of balancing recognition of harm to the targeted physician and their duty to provide care. For example, the institutional response should be to deny reassignment requests based solely on bias and bigotry unless the patient is in imminent danger or medically unstable.
Healthcare organizations should identify and prioritize necessary actions when staff members are faced with expressions of racism. Importantly, clinicians of color should not bear the burden alone. The authors wrote, “health care administrators in their role as leaders must be at the forefront of raising awareness and combatting white fragility.” Moreover, they should require a firm commitment from the organization’s shareholders to support and enforce policies that acknowledge the expression of racism and actually address the racist behavior, even if it means holding difficult or awkward conversations. These policies should include microaggression and overt expressions of bias.
The investigators suggested that in the presented case, the attending physician should have described Dr. C’s talents to the patient and gently but firmly pointed out the patient’s unnecessary or intolerable behavior. Furthermore, the attending physician should have checked in with Dr. C following the incident, offering to help debrief her or seek counsel on how to intervene in such a situation. The investigators stressed that these actions require awareness and skill for intervention, which can be enforced through proper policies.
Reference
Garran AM, Rasmussen BM. How should organizations respond to racism against health care workers? AMA J Ethics. 2019;21(6):e499-e504.
