Do racial barriers impede care between doctors and patients? (Getty Images)The presidential election has triggered a national discussion on race in America. In her latest “Doctor and Patient” column, Dr. Pauline W. Chen starts a conversation about the racial barriers that remain in the health care setting.
Dr. Chen recalls the words of a fellow surgical resident named Eric, who is African-American.
“You know, Pauline,” he said, “there are a lot of times when I go to a patient’s room for the first time and they ask me, ‘Are you transport? Are you here to wheel me to radiology?’ I can remember Eric shaking his head as he spoke. “They never assume I’m one of the doctors.”
Dr. Chen explores the racial divide in medicine in her latest column, “Confronting the Racial Barriers Between Doctors and Patients.”
Has race made a difference in your medical care? Have you noticed racial barriers as a doctor or patient? Join Dr. Chen in the discussion below.
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The role racism plays in this would be easier to tease out were it not for affirmative action. Black doctors are admitted to medical school with objectively lower credentials, and it is not an act of racism to acknowledge this. Apprehension at being cared for by a black doctor given this is rational.
— HBombDr. Chen is clearly a crusader for improving what is wrong with American medicine. This is good. She has become a personal-experiences journalist in hre quest to perform this mission. But I hope I never have her as one of my surgeons. She spends so much time trying to be sensitive to the pain of others that I have to wonder what internal dialogues she is attempting to counteract.
Most surgeons just want to cut into you. That is what they do. It is an irony of this most barbaric form of medicine that one must hurt a patient in order to help him or her. But if and when I really need a surgeon, I want somebody who is not only eager to cut into me, but who spends their time learning how to do this best. If I thought they were a hand-wringing worry-wart, I’d find somebody else.
As for the issue of racial biases, a study on this issue that the NY Times reported on recently showed that much of the bias was unconscious. I have to wonder how much can be done about such biases?
At some point, we all have to get on with the business of being who we are without a lot of second guessing. If you believe your doctor has unconscious biases against you, find a new doctor. But don’t be surprised if it turns out you also feel the same way about your new doctor. At that point, you have to ask yourself if it is the doctor, or if it is you. Biases go in both directions.
— Rob L, N Myrtle Beach SCAt first, when this blog started out, I assumed Pauline was just another mealymouthed hypocrite self-promoter telling us what we wanted to hear. But no, she seems to really mean the things she says. Good to know there’s at least one like her out there.
Correct terminology (negative reinforcment) and factual accounts (she did not actually operate on the liver-squanderer) need some work, but then, she is a lay journalist.
The transport episode was hilarious. I try not to be biased. Recently in a hospital I called out “Nurse!” to one of the whitecoats. He paused, flustered, apparently a doctor, but did not correct my mistake, and obediently came hither.
After all, there are more nurses than doctors in a hospital, so that should be the default setting, for both sexes.
— Susanna[i]“Recently in a hospital I called out “Nurse!” to one of the whitecoats. He paused, flustered, apparently a doctor, but did not correct my mistake, and obediently came hither.
After all, there are more nurses than doctors in a hospital, so that should be the default setting, for both sexes.”[/i]
Is that supposed to be funny?
Instead of yelling out at random people, you could do the rational thing and use the call button. You know, the mode of communication thats installed in every patient room so that you can get instant communication with your nurse or somebody at hte front desk who can relay the info to your nurse.
— patriciaWith the incredible range of literature on disparities available today, I am appalled at the poor choice of examples. Small cell lung cancer is NEVER treated with surgery, always with chemotherapy; differences in surgical rates between the races is a completely irrelevant statistic as no patient of any race should receive surgery.
That being said, racial disparities do exist and it’s a shame. I don’t think it will be fixed by writing about it, unfortunately. I agree with #2 that what bias remains is unconscious and the main solution is to properly educate the next generation. Until then…
— AaronI am not sure whether this fits in to this race discussion at all, but stereotyping by patients comes to mind. During residency, my female colleagues constantly complained of being called or treated as a nurse by patients. I recognize the hard work and dedication of nurses. The point was many patients (especially the elderly) have this preconceived association between female and nurses in the hospital, while in reality many women are doctors and substantial number of nurses are male.
Also, a practical advice to Susan (#3): in the hospital, squeaky wheels don’t necessary get the grease first. For most healthcare workers, the loudest patients screaming “NURSE!” are usually the least sick (i.e., not comatose) and hence needs attentions last. Listen to Patricia and use the call button in the future.
— NYCRealistDr. Chen,
I’m wondering if you can distinguish between the assumptions people make because you are Asian American vs. the assumptions people make because you are a woman. I think a number of patients must have an unconscious conception that doctor = white male. The number of times I’ve walked into a room and been assumed to be a nurse are too many to count. I’ve also observed patients addressing the medical student rather than the female chief resident. Most patients react well when corrected and the following relationship is successful. How do you deal with those that don’t? I had one patient insist on calling me by a feminine diminutive of my first name which I found disrespectful.
I agree about the importance of challenging our own conscious/or unconscious biases whether about race, or as can also be a problem, people who carry certain diagnoses.
As a patient I’ve found personality and practice style the most salient and much more important than gender or race. I tend to have poor relationships with authoritarian doctors and insecure doctors. Non authoritarian, patient centered doctors who are open to questions and suggestions and comfortable admitting when they don’t know something are usually fine.
— m.a.“So I, like others, unconsciously tap into past experiences in order to bolster the connection and bring a greater sense of familiarity to the interaction. And it’s difficult to acknowledge that what I have tapped into may not always be fair.”
Isn’t that what stereotypes are, basically: a mental shorthand for quickly assigning people who enter into our lives a “category” so we can relate to them in some fashion? That doesn’t make them right, or even useful, ultimately, but when one’s interaction with someone is brief, as the average medical interaction is, it’s not surprising that people resort to mental shorthand.
The advice to take one’s time and get to know each other is probably the best that can be given. How to fit that into the 10 or 15 minute medical visit that usually occurs is another question.
— ShirleyIt really is difficult to tell who’s who in a hospital. Within the limits of practicality, we ought to get back to hospital uniforms.
While the white nurses’ uniforms of the 60’s have become impractical, at least you could tell a doctor from a nurse.
There ought to be distinct uniforms for nurses, lab personnel, transport, etc. Doctors should also have a dress code. We should not have everyone running around in the same color scrubs.
— jackJack, the reason all the uniforms have become similar is because the hospital doesn’t want you to know the level of training or experience of the person taking care of you. They will frequently send in a “nursing assistant” or “LPN” with one year of post high school training with no ID or identifying information and let you know its “nursing staff”, so that you’ll be fooled into thinking you have an RN taking care of you (RNs have significantly more formal education and training). Same for physicians, PAs, and so forth. If everyone wore distinguishing uniforms the hospital wouldn’t be able to get away with it.
— InsiderI agree with Jack. I work part-time in a hospital, and unless I get close enough to read the name tags, I often have difficulty knowing who is who. Most of the doctors will throw a white lab coat on over their scrubs, so this helps, but everyone else looks a lot alike, as far as dress goes.
— ShirleyWhen I am sick, miserable, hurting, need help, speak English to me is all I ask. I am sorry I am not multilingual, don’t speak Hindi or Spanish or Farsi, am not feeling politically correct, not sympathetic with your difficulties in an Eng-speaking country–I need to communicate with as little difficulty as possible.
— Star#10. Right now, I’m just talking about distinguishing a doctor from a nurse from a transport person, etc.
If all nurses wore green uniforms, you could distinguish RNs from LPNs by a stripe of some sort. At least you would not confuse a nurse with a transport person, who would wear blue, for instance.
Doctors should have a dress code, but cannot wear uniforms because most are in and out of the hospital throughout the day.
— jackI don’t know if this is my age (38) or my geography (Toronto, Canada), but I don’t know anyone (anyone under 70) who is concerned with the skin color of their doctor.
Hopefully we will be rid of this prejudice as soon as the old bigots pass on - heck they will probably die sooner if they keep refusing medical treatment because their doctor doesn’t have the same shade of skin.
— DR“I have prided myself on being as fair and as compassionate a doctor as I could be. But I am also very much the daughter of Taiwanese immigrants; and when, for example, I see patients or colleagues who come from a similar background, empathy comes almost automatically.”
It’s human nature and almost innate. As the son of Taiwanese immigrants who grew up in the prairies of Saskatchewan, I was more familiar with Ukranians and ice hockey because of the lack of Asians in that part of Canada. Yet when I moved to California, where there is no majority of any ethnic group, I had more empathy automatically for Asians I interacted with.
As doctors, it is our job to overcome these natural tendencies and make patients from all backgrounds be comfortable. As members of the public, however, we must continue to be dissatisfied with the disparity in medical outcomes among the different racial groups.
Davis Liu, M.D.
— Davis Liu, M.D.Author of Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America’s Healthcare System
http://www.davisliumd.com
http://www.davisliumd.blogspot.com
A director of surgery in the 1970’s at a State University of New York State medical school-medical center denied being a racist when it was discovered that he had written after an interview with a prospective resident, “He has very dark skin.”
When asked during a deposition why he made this notation he said, “I thought it was a good clinical observation and worthy of being noted.”
When asked how this observation and notation would assist in his decision about accepting this candidate he had nothing to say.
When asked if he ever wrote down any similar types of remarks about any white candidates (i. e. very white, red hair, dark complexion, freckles, etc.) he said, “No. There was no need to ever do so.”
When asked if he thought he was racist, wrote a racist comment or if his notation could be perceived as racist in any way he said, “Of course not.”
So racism masked by the complexity of medicine is ripe for expressions and justifications of actions and judgments based on color between doctor and doctor, doctor and patient, doctor and other staff, patient and other staff, and patient and patient . Ignorance and bias take time to overcome. Stupidity and hatred are rarely turned. We have a new half white**, half black President. Even saying that reflects a racism in our society. Let’s hope we can move forward at least 50% of the way during the next few years.
** Obam’s mother, a white mid-westerner, is described at Wikipedia as having:
“… English, Irish, German, and Cherokee heritage from her parents. She was a distant cousin of Vice President Dick Cheney, George Bush and Harry Truman….” His grandfather was in the Army, stationed near Leavenworth, Kansas and her father joined the service after Pearl Harbor.
So I guess in an ironic way, Obama has been paling around with actual WMD terrorists.
— ed gThis past spring I had an operation at a community hospital in a sizeable tiown in NE Pennsylvania, and I must admit to its having felt a bit unnatural as all the staff was white (I’m white). Actually my surgeon was originally Mexican, but I include that as white. After being discharged. I received one of those follow-up phone calls asking how I rated the experience, and immediately said it was strange because I saw no black faces. Pobably television dramas have us programmed to expect a certain ratio of population diversity. Watch “House”, and you see that he has a black adversarial colleague! It’s come about that I no longer feel comfortable in all-white settings.
— Rozmarija GraudsDr. Chen and “Eric” use these examples not to show their utter disappointment at being mistaken for a nurse. Frankly, I am jealous of the nurses - they get to spend much more time with the patients than I do. Instead, they are using these experiences as examples to show that we deal with race subconsciously. So while the discussion has turned to uniforms, that may answer the immediate question of “who’s the doctor?” but it will not solve the underlying issue of how we subconsciously deal with race.
To that end, I suggest trying to make a habit of bringing the subconscious to light. Too often ‘racist’ is used as a pejorative label. Its “those people” out in Appalachia that said they’d never vote for a black man.
The problem with this is that everyone thinks they can say “I’m not a racist” and that solves the problem. See, I’m not like that racist person over there, so I am not racist. We are even stereotyping racists and since we don’t look or sound like “them” we assume all of our decisions are free from racism because “I am not a racist”. Racism is not an inherent trait. It is not something ingrained in our DNA.
We all stereotype by race (and class among other categories) subconsciously. Race is a factor in every interaction we have with people we do not know well, whether we choose to admit it or not. But to ensure it does not become a barrier to patient care, we need to second-guess ourselves in every decision we make to ensure we are not making decisions based on pre-formed judgments (I wish #1 had second-guessed him/herself before writing that post).
I do not mean to imply we should hamper ourselves worrying about race all the time. A quick second to ask yourself the question will do. But when we ignore questions of race because we have declared ourselves not to be racist, that’s when we are in danger of letting unconscious decisions affect our interactions with doctors, nurses, and patients.
Stereotyping is natural. Letting those stereotypes govern our behavior without checking them - that is the root of racism.
— tnfalphaExcuse me, that’s what’s lacking in the medical profession. Doctors that are more sensitive to the pain of others! I don’t want a doctor operating on me that has no awareness or just plain lacks the ability to understand and communicate with patients feelings and experiences.
— msAbout 30 years ago, I was suddenly stricken, doubled over. A neighbor in the building—to which I had moved just months before, from out of state—drove me to the closest ER, where we waoted as people with gunshot wounds were wheeled through.
— Annemarie46In the cubicle, I was told that the location and severity of my pain could mean a gynecologic emergency, and that a specialist would shortly be by find out.
At the sight of the specialist, a very tall black man, I said I had changed my mind and wanted to go home. I just couldn’t submit to that exam by a black doctor. It was racial, cross-racial, and it crossed my comfort zone so far that despite the agony of what turned out to be a big and badly stuck kidney stone, I could not allow the exam.
I have thought about this in the decades since. I think it makes me a racist by almost any definition of that word. But what did I owe my own comfort? My own peace of mind? Anything at all? Maybe some “racism” is just human nature at its most raw, and maybe not all racists would be compatible with Strom Thurmonds and Simon Legrees. Maybe there are degrees of racism too, and not every degree is a Hitlerian affront to society.
. . . how brave of you Dr. Chen. For someone in your position to make such an admission, you’ve earned my highest degree of respect. It takes a lot to unpack and then reveal - to the world - something that doesn’t reflect well on oneself. This is really PROGRESS at work! Let the healing begin:-)
— sunriseAs a nurse and a 27 year old white female, I have only been mistaken for a physician once, when I was wearing business casual clothes (RNs wear green scrubs in my hospital).
On the other hand, my husband, also an RN, is a thirty-something Asian American male and is mistaken for a physician by patients and staff alike ALL the time, even when he’s wearing his RN uniform.
So, this begs the question: is he mistaken for an MD because he’s Asian or male–or both? And am I assumed to be an RN because I’m female or white–or both?
— FLD, RNAs a young woman of 33 I moved to a new area of the country and asked around for suggestions for a GYN. I chose to see one highly recommended doctor and remained his patient for more than 15 years before he retired. Shortly after that first appointment, though, in a group of women discussing their doctors, someone who recognized his name asked me how I felt about the fact that he was black; specifically, because his hands “touched me”…. almost forgot: yes, I’m white. I found the question appalling and said so. Still do, and I’m now 65.
— lisabettaTo Annemarie46
Thanks for your honesty. The truth is every patient has the right to refuse any treatment… at the end the reason is irrelevant. I can certain understand most patients don’t want medical students to draw their blood. Is that a kind of discrimination?
It seems the conclusion inevitably may be that we are all bigots at some level. For instance, as a “humanist”, I think religious people who are trying to ban the teaching of evolution in public schools are America’s version of the Taliban who will drag our civilization back to medieval ages. By the same token, these people may consider people like me godless infidels who deserve to be burnt in hell. So aren’t we both bigots?
— NYCRealistIn response to the last post:
Most medical schools look at the whole applicant before making a decision to grant or deny the applicant. Therefore, student from various ethnicity (including causcasians) can get into medical school with “lower” objective “credential”. It all depend on the circumstances surrounding the application ie demonstrated competencies given the individual’s stressors. There are no general standards to determine acceptances. Regardless, you cant be a doctor without passing the boards(1, 2CS, 2CK). I believe this is an objective criterion across the board regardless of race.
- What if you are the black physician with all the apprehensive patients because of your race despite graduating top of your medical school class? Sure you will love that :)
— G