African American patient not wanting care from Caucasian Hospital providers

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sliceofbread136

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I am currently dealing with a similar situation to this in my third year, and I've been thinking about the ethics behind it. Is this something that should be accommodated? How different would the story be if a white patient was refusing care from black providers? Keep in mind this is inpatient where you generally don't have a choice in who your attending physician is
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Are you shadowing somewhere, or volunteering?

Sounds like a racist. They're everywhere, and dealing with them is part of learning medicine, IMO.
 
sliceofbread136 said:
I am currently dealing with a similar situation to this in my third year, and I've been thinking about the ethics behind it. Is this something that should be accommodated? How different would the story be if a white patient was refusing care from black providers? Keep in mind this is inpatient where you generally don't have a choice in who your attending physician is
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Pretty sure this thread should be in Allo/Clinical Rotations forums for better input
 
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Remember the general rule of thumb- sick people don't b*tch. I used to have to deal with this type of nonsense all the time as a paramedic in the ED. The end result was normally a charge nurse politely telling them to take their business elsewhere if they so desired.

As an MS3, this is not a situation that you need to handling in any way, shape, or form. That needs to be punted to the pt's attending and nursing administration. If that happens, just politely smile and say "Yes sir/ma'am I'll go talk to my superiors and see what we can do." Don't get involved.
 
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Medic5522 said:
Remember the general rule of thumb- sick people don't b*tch. I used to have to deal with this type of nonsense all the time when I worked in the ED. The end result was normally a charge nurse politely telling them to take their business elsewhere if they so desired.

As an MS3, this is not a situation that you need to handling in any way, shape, or form. That needs to be punted to the pt's attending and nursing administration. If that happens, just politely smile and say "Yes sir/ma'am I'll go talk to my superiors and see what we can do." Don't get involved.
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Yes of course, I was more pondering what should be done in the position where you would be the attending
 
sliceofbread136 said:
Yes of course, I was more pondering what should be done in the position where you would be the attending
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You can be "the nice guy" and see if you can pawn said pt off to someone on your service that is of more "appropriate" ethnicity. If successful, everybody wins. But that assumes that the pt only cares about the attending.

Since you said the pt doesn't want to be cared for by white "hospital providers," I'll assume that means everyone- attendings, residents, students, nurses, techs, etc. That's...not possible. You can be the "slightly less nice guy" and try to figure out why the pt feels that way and then attempt to mollify said concerns. Sometimes it works, sometimes it doesn't. If it doesn't, you get the administration involved. 99 times out of 100, those patients want to speak with some sort of administrator anyway. They'll get an apology and politely told that the hospital cannot accommodate such requests. If they don't agree, they can leave and take your business elsewhere. No, you cannot be transferred to another facility. However, I'd pay to hear the phone calls between transfer centers and see "dislike of hospital staff ethnicity" on an EMTALA transfer form.

However, if the pt gets rude and/or aggressive about it, the dynamic changes. The proverbial fuse gets shorter and you spend a lot less time trying to play nice. Security and/or PD get called, and out they go. Or better yet, the pt gets arrested for a&b on healthcare workers and is held in custody at the facility for treatment until discharged for booking.

There very well may be other (better?) ways of handling this, but this is how I've seen it play out countless times.

TLDR: Try being nice, ensure them they'll get the best care possible. If unsuccessful, consult administrators, security, PD, etc PRN.
 
The tv show black-ish did a good episode on this (kinda relates to this topic). title of episode was "Dr. Hell-no"
 
Mad Jack said:
The only things we tend to accommodate are requests about the sex of the provider for religious reasons. Race though- hell naw.
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That's also a bit easier, demographics-wise.
 
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mehc012 said:
That's also a bit easier, demographics-wise.
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Especially from the nursing side. They're the ones doing the vast majority of the hands-on care. Unless we're talking more procedural medicine, the docs pop in every now and then for a few minutes and move on. Nursing staff is stuck dealing their difficult patient for their entire 12 hour shift, minus a 30 minute lunch break that they may or may not end up getting.
 
Medic5522 said:
Especially from the nursing side. They're the ones doing the vast majority of the hands-on care. Unless we're talking more procedural medicine, the docs pop in every now and then for a few minutes and move on. Nursing staff is stuck dealing their difficult patient for their entire 12 hour shift, minus a 30 minute lunch break that they may or may not end up getting.
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Personally, I always insist that every member of my healthcare team be Australian Aboriginal, at least 50% by blood. Documentation required. Torres Strait Islanders also accepted. Good thing I've been relatively healthy thus far... :xf:
 
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Good thing theres a surplus of non white providers. That said, if they complain they're really not that sick.
 
I think Goro posted an amazing article a while back on the importance of having black physicians because it affects the outcomes of the patients for a lot of reasons. (It was in a thread about people complaining about URMs getting in with lower MCATs or something like that.) It was really eye opening to me.
 
In my experience people who make these sorts of requests are 100% of the time a grade-A pain in the ass. Whenever somebody says they don't want the medical student involved I feign a disappointed frown and then quickly and deliberately make my exit. Now I'm hoping this "no Caucasian providers" meme catches on.

Of course there are a lot of double standards and hypocrisy at work here, but, as I said in another thread, as workplace humiliations go this one is very much on the minor side. Forget the ethics of it and just focus on the politically correct answer, since this is the position every hospital will take.
 
sliceofbread136 said:
I am currently dealing with a similar situation to this in my third year, and I've been thinking about the ethics behind it. Is this something that should be accommodated? How different would the story be if a white patient was refusing care from black providers? Keep in mind this is inpatient where you generally don't have a choice in who your attending physician is
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Well yes the story would be different because in this country there is a HUGE difference in the history of healthcare providers and how black and white patients have been treated. Black patients have been historically been experimented on and yes this has definitely caused some tension among some patients over the years.

Now I'm not saying it's right for a black patient to request a black physician, but studies have shown that all races feel more comfortable with a provider that is their own race. I also think that people should realize the history behind why someone might feel that way before jumping to conclusions and trying to compare apples and oranges in regards to what would happen if a white person had the same preference.

Most of the time I haven't seen these preferences honored, but explaining it to the patient goes a long way instead of immediately dismissing them.
 
sliceofbread136 said:
I am currently dealing with a similar situation to this in my third year, and I've been thinking about the ethics behind it. Is this something that should be accommodated? How different would the story be if a white patient was refusing care from black providers? Keep in mind this is inpatient where you generally don't have a choice in who your attending physician is
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What is a "provider"?
 
AMEHigh said:
Well yes the story would be different because in this country there is a HUGE difference in the history of healthcare providers and how black and white patients have been treated. Black patients have been historically been experimented on and yes this has definitely caused some tension among some patients over the years.

Now I'm not saying it's right for a black patient to request a black physician, but studies have shown that all races feel more comfortable with a provider that is their own race. I also think that people should realize the history behind why someone might feel that way before jumping to conclusions and trying to compare apples and oranges in regards to what would happen if a white person had the same preference.

Most of the time I haven't seen these preferences honored, but explaining it to the patient goes a long way instead of immediately dismissing them.
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People feel more comfortable with a provider of their own race because they are ****ing racist. This isn't rocket science.

I think it's interesting that you feel comfortable ascribing the request to some sort of awareness of tuskegee-like experimentation rather than simple racism which is about 200x more likely.
 
Wordead said:
People feel more comfortable with a provider of their own race because they are ****ing racist. This isn't rocket science.

I think it's interesting that you feel comfortable ascribing the request to some sort of awareness of tuskegee-like experimentation rather than simple racism which is about 200x more likely.
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lolwut.

You're right, it's not rocket science. African Americans not trusting the healthcare system is very well documented and published. However, your comment is way off base because not trusting someone does not equal racism, and the healthcare system has actually given AAs good reason not to trust it.
 
Wordead said:
People feel more comfortable with a provider of their own race because they are ****ing racist. This isn't rocket science.

I think it's interesting that you feel comfortable ascribing the request to some sort of awareness of tuskegee-like experimentation rather than simple racism which is about 200x more likely.
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Please do your research before commenting as that is not racism in a great deal of cases.
 
W19 said:
We are falling in line very quickly... Even med students are using the word 'provider'.
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I just use it when referring to more members of the healthcare team than just the physician. During your average hospital stay, you're going to interact with a LOT of non-physician staff.
 
Wordead said:
People feel more comfortable with a provider of their own race because they are ****ing racist. This isn't rocket science.

I think it's interesting that you feel comfortable ascribing the request to some sort of awareness of tuskegee-like experimentation rather than simple racism which is about 200x more likely.
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Actually you are right in regards to racism....

There is also research that has shown that blacks prefer black healthcare providers due to personally experiencing discrimination in healthcare.

So yes, you are correct that racism is also in play...racism towards blacks and African Americans.
 
mehc012 said:
I just use it when referring to more members of the healthcare team than just the physician. During your average hospital stay, you're going to interact with a LOT of non-physician staff.
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I will use their credential i.e. Registered Nurse, Nurse Practitioner, Physician Assistant, Dr. [insert] for MD/DO/DDS/DMD/DPM etc..
 
W19 said:
I will use their credential i.e. Registered Nurse, Nurse Practitioner, Physician Assistant, Dr. [insert] for MD/DO/DDS/DMD/DPM etc..
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Right...if you're talking about one of them. If you're trying to talk, collectively, about all the RNs, BSNs, NPs, PAs, MDs, DOs, PTs, OTs, Pharm.Ds, nutritionists, LVN/LPN, etc., that the patient may interact with, you can either list all of them like I just did, or use a single word which includes all of the above. I choose the latter.
 
@mehc012 I worked in healthcare for a few years and I never used the word provider. Maybe it was not needed in any context... Can you give an example.....?
 
W19 said:
@mehc012 I worked in healthcare for a few years and I never used the word provider. Maybe it was not needed in any context... Can you give an example.....?
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Sure...the title of this thread. People have been assuming that the use of the word 'providers' indicates that the request was not limited to the physician. Otherwise, they could have just said 'physician'.
Medic5522 said:
Since you said the pt doesn't want to be cared for by white "hospital providers," I'll assume that means everyone- attendings, residents, students, nurses, techs, etc.
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Wordead said:
People feel more comfortable with a provider of their own race because they are ****ing racist. This isn't rocket science.

I think it's interesting that you feel comfortable ascribing the request to some sort of awareness of tuskegee-like experimentation rather than simple racism which is about 200x more likely.
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Care to define "racist"?
 
NontradCA said:
Assigning characteristics to, and or discriminating others based on their race, with attempt to purport one group as inferior to the other.

You're a racist.
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Now, this is interesting.

Wordead stated that a preference for a provider of one's race demonstrates the fact that one is "racist." I'd like to know what leaps of logic led you to assume that such a preference has anything to do with feelings of racial superiority. Or, is it the case that you disagree with his post?
 
Dave89 said:
Now, this is interesting.

Wordead stated that a preference for a provider of one's race demonstrates the fact that one is "racist." I'd like to know what leaps of logic led you to assume that such a preference has anything to do with feelings of racial superiority.
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Thanks for agreeing with me. I said that's not racist. He was saying it was. Learn to read. I was calling YOU a racist.
 
NontradCA said:
Thanks for agreeing with me. I said that's not racist. He was saying it was. Learn to read. I was calling YOU a racist.
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I added a sentence before you responded.

EDIT:I had not noticed post #23.
 
NontradCA said:
lolwut.

African Americans not trusting the healthcare system is very well documented and published. However, your comment is way off base because not trusting someone does not equal racism, and the healthcare system has actually given AAs good reason not to trust it.
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why see the doctor in the first place if you dont trust them?
 
NontradCA said:
lolwut.

You're right, it's not rocket science. African Americans not trusting the healthcare system is very well documented and published. However, your comment is way off base because not trusting someone does not equal racism, and the healthcare system has actually given AAs good reason not to trust it.
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Oh are black doctors not a part of the healthcare system now? Or do black doctors inherently never do anything wrong to black patients?

And you are absolutely wrong. Not trusting a doctor on basis of their race? How else do you define that. You can play all the mental gymnastics you want, but that's racism in my mind. I frankly dont give three ****s about this since I'm not black or white (frankly the only races anyone really refers to in these discussions) but both groups have a large chunk of racists and it's a joke to pretend like black people can never be racist or that it's somehow justified by a history of medical experimentation. It's hypocrisy.
 
Wordead said:
Oh are black doctors not a part of the healthcare system now? Or do black doctors inherently never do anything wrong to black patients?

And you are absolutely wrong. Not trusting a doctor on basis of their race? How else do you define that. You can play all the mental gymnastics you want, but that's racism in my mind. I frankly dont give three ****s about this since I'm not black or white (frankly the only races anyone really refers to in these discussions) but both groups have a large chunk of racists and it's a joke to pretend like black people can never be racist or that it's somehow justified by a history of medical experimentation. It's hypocrisy.
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No one talked about justice. No one said blacks can never be racist. We've talked about the way things are. It's been shown that people, no matter their race, are more comfortable being seen by a physician like themselves. A lot of this comes from culture and just plain ignorance stemming from little to no exposure to other races. Wrong doings add another layer to this. Show me some data on black physicians or patients doing wrong, since you bring it up.
 
Wordead said:
Oh are black doctors not a part of the healthcare system now? Or do black doctors inherently never do anything wrong to black patients?

And you are absolutely wrong. Not trusting a doctor on basis of their race? How else do you define that. You can play all the mental gymnastics you want, but that's racism in my mind. I frankly dont give three ****s about this since I'm not black or white (frankly the only races anyone really refers to in these discussions) but both groups have a large chunk of racists and it's a joke to pretend like black people can never be racist or that it's somehow justified by a history of medical experimentation. It's hypocrisy.
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It is true there are racists within all races and sometimes these requests from either side are due to racism.

One thing about black patients requesting black doctors though... due to discrimination that a lot of black people have faced from doctors of other races, many of them feel they will get a fairer shot at good medical care from another black doctor. They are not necessarily racist, just wary due to past experiences. This might be something that may be replicated through the races, I don't know.
 
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NontradCA said:
No one talked about justice. No one said blacks can never be racist. We've talked about the way things are. It's been shown that people, no matter their race, are more comfortable being seen by a physician like themselves. A lot of this comes from culture and just plain ignorance stemming from little to no exposure to other races. Wrong doings add another layer to this. Show me some data on black physicians or patients doing wrong, since you bring it up.
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I agree that this is "the way things are" and the rest of your statement. The only difference between what we are saying is that you are ready to dismiss it due to other circumstances, whereas I think a spade is a spade and it's racism regardless of the thought process.

I dont even know what you're asking for on data.
 
I'm going to tread lightly and write: Plenty of groups get to choose what specific characteristics their doctor will have (or who becomes a doctor) and no one cries "racist". It could be something simple as picking a hospital based upon demographics, what the doctors look like, which schools residents come from and so on. Are those people racist?

I've seen patients who were more comfortable with a certain race, sex, ethnicity, religion, etc...Most of the time it wasn't too difficult accommodating them.
 
Wordead said:
I agree that this is "the way things are" and the rest of your statement. The only difference between what we are saying is that you are ready to dismiss it due to other circumstances, whereas I think a spade is a spade and it's racism regardless of the thought process.

I dont even know what you're asking for on data.
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Nontrad is asking for data on black patients perceiving that black doctors have discriminated against them. I mentioned above that it's not only historical racism that sometimes has minorities requesting a physician of their race, but personal past experiences of discrimination. Then, you went on to say "Or do black doctors inherently never do anything wrong to black patients?" Most discrimination occurs against minorities by people of another race. I don't think that's a hard concept to grasp, but where is the data about black doctors discriminating against black patients?

You also asked "are there no black doctors anymore?" I don't understand how as someone who I presume is book smart hasn't noticed the fact that the overwhelming majority of physicians in this country are white. I think something like 3% of physicians are black (I think 4% identify as hispanic). And whether you like it or not, it does play a role in healthcare in this country due to the demographics of this country.

I can tell you're not going to agree with many of us, but maybe this conversation will help expand your mind beyond just yelling "that's racist!" when a discussion comes up in regards to race and culture in this country.
 
AMEHigh said:
Nontrad is asking for data on black patients perceiving that black doctors have discriminated against them. I mentioned above that it's not only historical racism that sometimes has minorities requesting a physician of their race, but personal past experiences of discrimination. Then, you went on to say "Or do black doctors inherently never do anything wrong to black patients?" Most discrimination occurs against minorities by people of another race. I don't think that's a hard concept to grasp, but where is the data about black doctors discriminating against black patients?

You also asked "are there no black doctors anymore?" I don't understand how as someone who I presume is book smart hasn't noticed the fact that the overwhelming majority of physicians in this country are white. I think something like 3% of physicians are black (I think 4% identify as hispanic). And whether you like it or not, it does play a role in healthcare in this country due to the demographics of this country.

I can tell you're not going to agree with many of us, but maybe this conversation will help expand your mind beyond just yelling "that's racist!" when a discussion comes up in regards to race and culture in this country.
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I think you misread my post. I didnt ask if there are no black doctors. Nontrad said black people had cause to distrust the healthcare system, I was saying that black doctors are just as much a part of it as a white doctor so it makes no sense to trust black doctors unless a persons race overrides the fact that they're a physician. I do think that more minority physicians is a good thing. I don't agree that there is any justification to request a physician of your own skin color or avoid physicians of other races. The "they get me" argument is ridiculous on the face of it and I consider it a very thin veil for racism.

I hate resorting to the old what if you replaced black with white in everyones posts but if a white patient refused to see a black doctor it'd be racism regardless of what "bad experiences" he mightve had with black docs or black people in general.
 
NontradCA said:
lolwut.

You're right, it's not rocket science. African Americans not trusting the healthcare system is very well documented and published. However, your comment is way off base because not trusting someone does not equal racism, and the healthcare system has actually given AAs good reason not to trust it.
Click to expand...

If you are not trusting someone because of their race, it is almost by definition, racist.
 
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