A recent article in the academic journal Annals of Internal Medicine has given rise to a lively exchange of letters. The article, entitled The Racist Patient, touches on some issues many would prefer to ignore. Here's the start of the piece by Sachin H. Jain, MD, curently at the Boston Veterans Affairs Medical Center in West Roxbury, Massachusetts:
* * *
In my final months of residency, I was summoned to see an angry patient. Mr. R. was furious that our pharmacy did not stock his brand of insulin. He wanted to issue a complaint.
“You guys always mess up my insulin whenever I am here. I told the other doctor, and now I'm telling you. You guys just can't get it right.”
“I'm sorry,” I told him. “If you prefer, your family can bring your insulin from home and our nurses can administer it. Would that be an acceptable solution?”
“You people are so incompetent.”
Uncertain of how I might best diffuse the situation, I looked uncomfortably in the direction of my patient's son, who was seated at the bedside.
“You look at me when I talk to you,” Mr. R. commanded. “Don't you look at him.”
“I'm sorry. Why don't I come back later?”
As I uncomfortably walked out of the room, he launched a grenade.
“Why don't you go back to India!”
On pure instinct, I responded, “Why don't you leave our [expletive] hospital?” To underscore my point, I repeated myself.
I exited the room in a cold sweat.
* * *
In a later issue of the Annals, letter-writers shared various ideas about how one might best react in that situation. "[In a similar situation], my personal feelings were immaterial [to the proper treatment of the patient]," said a Dr. Galishoff of Alabama, who had experienced anti-Semitism. Dr. Sahai, of Houston, Texas, who identifies himself as a physician of Indian descent who has faced similar remarks, says, "I have never lost my cool in the presence of the patient."
Even Dr. Jain himself wrote a letter of response to "clarify misconceptions." He protests, "I am in no way proud of how I reacted to [the patient's] incendiary comments."
This is where I depart from the opinions already expressed, though I should take pains to point out that I would never, I hope, make a remark like Dr. Jain's even if faced with such an obnoxious patient.
My point is this: sometimes professionalism is too weak a vessel to contain our very real human feelings and emotions in stressful situations. I am not sure how Dr. Jain should otherwise best have expressed his displeasure in a way that conveyed the extent of his hurt. I agree that a strongly worded letter, composed later with due deliberation, would be an ideal response in tune with the spirit of professionalism. But this does not change the fact of emotions: when we are angry, we get angry, and we respond.
What better way - as a human being, not just as a physician - to express how horrified we are at naked racism than to call out the person who launched, as the author put it, that grenade? Curses are a powerful expression of injury, and were Dr. Jain to have confined himself to a letter, or the pallid adjective "appropriate," the patient might not have learned anything at all.
Cursing at patients is not part and parcel of professionalism, and I hope I would never do so. But - then again - I hope I would never be the target of such a racist remark. Sometimes, our human feelings burn through the veneer of professionalism and we are left as insulted as anyone.
Have you ever had a sensitive or offensive exchange with a doctor or patient? How did you react?
* * *
In my final months of residency, I was summoned to see an angry patient. Mr. R. was furious that our pharmacy did not stock his brand of insulin. He wanted to issue a complaint.
“You guys always mess up my insulin whenever I am here. I told the other doctor, and now I'm telling you. You guys just can't get it right.”
“I'm sorry,” I told him. “If you prefer, your family can bring your insulin from home and our nurses can administer it. Would that be an acceptable solution?”
“You people are so incompetent.”
Uncertain of how I might best diffuse the situation, I looked uncomfortably in the direction of my patient's son, who was seated at the bedside.
“You look at me when I talk to you,” Mr. R. commanded. “Don't you look at him.”
“I'm sorry. Why don't I come back later?”
As I uncomfortably walked out of the room, he launched a grenade.
“Why don't you go back to India!”
On pure instinct, I responded, “Why don't you leave our [expletive] hospital?” To underscore my point, I repeated myself.
I exited the room in a cold sweat.
* * *
In a later issue of the Annals, letter-writers shared various ideas about how one might best react in that situation. "[In a similar situation], my personal feelings were immaterial [to the proper treatment of the patient]," said a Dr. Galishoff of Alabama, who had experienced anti-Semitism. Dr. Sahai, of Houston, Texas, who identifies himself as a physician of Indian descent who has faced similar remarks, says, "I have never lost my cool in the presence of the patient."
Even Dr. Jain himself wrote a letter of response to "clarify misconceptions." He protests, "I am in no way proud of how I reacted to [the patient's] incendiary comments."
This is where I depart from the opinions already expressed, though I should take pains to point out that I would never, I hope, make a remark like Dr. Jain's even if faced with such an obnoxious patient.
My point is this: sometimes professionalism is too weak a vessel to contain our very real human feelings and emotions in stressful situations. I am not sure how Dr. Jain should otherwise best have expressed his displeasure in a way that conveyed the extent of his hurt. I agree that a strongly worded letter, composed later with due deliberation, would be an ideal response in tune with the spirit of professionalism. But this does not change the fact of emotions: when we are angry, we get angry, and we respond.
What better way - as a human being, not just as a physician - to express how horrified we are at naked racism than to call out the person who launched, as the author put it, that grenade? Curses are a powerful expression of injury, and were Dr. Jain to have confined himself to a letter, or the pallid adjective "appropriate," the patient might not have learned anything at all.
Cursing at patients is not part and parcel of professionalism, and I hope I would never do so. But - then again - I hope I would never be the target of such a racist remark. Sometimes, our human feelings burn through the veneer of professionalism and we are left as insulted as anyone.
Have you ever had a sensitive or offensive exchange with a doctor or patient? How did you react?
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