Disclosures No conflicts of interest 1 2/28/2019 Case You are - - PDF document

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Disclosures No conflicts of interest 1 2/28/2019 Case You are - - PDF document

Nov 06, 2022 381 likes •482 views

2/28/2019 DEALING WITH RACIST PATIENTS Ashley McMullen, MD Ambulatory Chief Resident University of California, San Francisco Zuckerberg San Francisco General Disclosures No conflicts of interest 1 2/28/2019 Case You are the provider

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2/28/2019 1

DEALING WITH RACIST PATIENTS

Ashley McMullen, MD Ambulatory Chief Resident University of California, San Francisco Zuckerberg San Francisco General

Disclosures

No conflicts of interest

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2/28/2019 2

Case

You are the provider preparing to see a Caucasian woman patient in the ED for cellulitis and substance use disorder. As you enter the room, you notice that she is quite

  • agitated. While trying to begin your evaluation, she

suddenly shouts “I don’t want any n*ggers taking care of me.”

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2/28/2019 3

How do you feel as the Provider?

  • You don’t want to make it seem like you can’t handle it, so

don’t bring it up to anyone

  • This patient is actually sick and really needs care.

Confronting her may make things worse and make care more difficult

  • You kind of hate this patient and don’t really care what

happens to her at this point

How do you feel as the Ally?

  • What is going on with the patient that they would

speak that bluntly?

  • How can you best support that provider without

making them feel worse?

  • Angry and offended on the provider’s behalf
  • What is the billing code for this in the EMR?
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2/28/2019 4 Five Ethical & Practical Factors

1.

Medical Condition

2.

Decision Making Capacity

3.

Reason for Request

4.

Options for Responding

5.

Impact on Providers

Paul-Emile, Smith, Lo, and Fernandez.

  • NEJM. 2016. 374:708-711.

Paul-Emile, Smith, Lo, and Fernandez.

  • NEJM. 2016. 374:708-711.
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2/28/2019 5

5 Ethical and Practical Factors

  • 1. Patient medical condition
  • If unstable, treat
  • 2. Decision-making capacity
  • Rule out delirium, dementia or psychosis

Paul-Emile, Smith, Lo, and Fernandez.

  • NEJM. 2016. 374:708-711.
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2/28/2019 6

5 Ethical and Practical Factors

  • 3. Reasons for the request
  • Ethically appropriate, occasionally. i.e. language

concordance, history of discrimination.

  • Rarely PTSD, i.e. veterans

Paul-Emile, Smith, Lo, and Fernandez.

  • NEJM. 2016. 374:708-711.
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2/28/2019 7

  • 4. Options for Responding to the

Request

  • Accommodate: Ask another provider to take over the

care of the patient. See if there is a family member or

  • ther proxy you can partner with
  • Negotiate: I just want to see the arm and then I am gone.
  • Place limits: You cannot use that language here.
  • Transfer: Offered only to stable patients and by attending

physician discretion

5 Ethical and Practical Factors

  • 5. Effect on Physician/Providers
  • No absolute ethical duty
  • Reasonable limits can and should be

placed on unacceptable patient behavior

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2/28/2019 8

LEGAL IMPLICATIONS

Patients have the right to refuse medical care.

  • Informed consent/battery

law/EMTALA all protect patients

Medical providers have employment rights

  • Workplace free from

discrimination/Title VII, 1964 Civil Rights Act

Common Remarks/Situations

But, where are you really from? What are you? Are you here to take my tray? Can I please speak to the real doctor?

Sorry I can’t seem to tell you and your colleague apart

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2/28/2019 9

TAKE AWAYS

  • Racist comments happen
  • Allies have an important role to play
  • You do not always have to accommodate
  • You can set limits
  • You can inform patients of their right to seek care elsewhere
  • It’s ok not to react perfectly - just remember to act!

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