Nazi tats

[docB]

---

Members don't see this ad.

So I?m working on this really sick guy last night in the ER and once again I?m confronted with tattoos of swastikas, SS markings, etc. I?m so jaded that nothing these yahoos do offends or even surprises me anymore but I started thinking that it must be really tough to deal with these knuckleheads if you?re one of the many people on their hate list. How do you deliver care to patients you find personally repugnant let alone dangerous? One of my favorite attendings from my residency is a short, black woman who marches up to the foot of the bed of these patients and says loudly ?Are you and me gonna? have trouble?? Every time I saw her do this the answer was ?no.? (Although once I did have to take down a patient who was trying to kill her but that was about an unrelated matter.) Anyway, dealing with these patients must be a slap in the face for people just starting out. Thoughts?

 

[Castro Viejo]

"Personally repugnant" and "dangerous" are two entirely different issues.

I don't think it's okay for a physician to reject a patient he finds "personally repugnant" or morally reprehensible. The reasoning is clear. Allowing physicians to freely withold care from someone they find repugnant could potentially lead to a situation where a physician rejects a patient for being of a different culture, a different ethnicity, or even from an entirely different part of town.

You are a physician, charged with the healthcare of those in need. How can you withold it from someone with whom you have some moral objection? The question that attending of yours asked the "skinhead" is wrong, nontheless. I thought ER docs were supposed to be good at establishing rapport quickly. 🙂

If a patient is found to be dangerous, as in the patient lurches at a physician wielding a knife or with the intention of harming the physician, sure, all bets are off.

I've met quite a number of patients in the last two years of med school with whom I have tremendous objection, but I treated them the same as all the other patients I found to be, at least in my book, good people. I haven't had the pleasure of being attacked by a patient, but I'll let you know what happens if that ever comes up. 🙂

 

[Macken]

Docs are there to provide health care to people that need it. Period. The end.

Personal philosophies have to be checked at the door. You're gonna run into a LOT of people that you don't like and even more that are personally offensive. It's just part of the territory. Tolerance is indeed one of the most difficult things to achieve.....

Good luck. I know it's tough and easier said than done! Grit your teeth when you have to....

 

[edfig99]

I don't think it's very realistic to check your personal beliefs at the door because even as professionals, what we do is heavily colored by our personal beliefs and experiences. why else would most places be practicing medicolegal versus evidence-based medicine. all it takes is one...

That being said, in an emergency situation I have always provided appropriate patient care. But I'd be lying if I said that I treated every "sociopath" or "derelict" the same way I treat my little old ladies on an inpatient service. Think of particular patient "types", that, though they may not be covered in swastikas and tattoos, these patients in general get a certain...different kind of treatment, at least they have in the hospitals i have rotated through as a med student and now near the end of my residency.... sicklers... demented nursing home residents... alcoholics... drug addicts. I have done what is medically appropriate as a professional, but my focus on what i hope to achieve with the patient is different, i.e. I have to get them off my service and back to their own environment vs really trying to establish rapport and even trying to recruit them to my continuity clinic. I mean, I'll take care of them of course, but I don't have to like 'em...

Should physicians not see patients that they found "morally reprehensible"? No.

can they? Sure.

medicine is like most other businesses -- you can choose who you provide service to. the AMA code of medical ethics states that patients are able to select whom they would like as a physician, and vice versa. "Physicians are free to choose whom they will serve. The physician should, however, respond to the best of his or her ability in cases of emergency where first aid treatment is essential. Once having undertaken a case, the physician should not neglect the patient." Caution should be taken with racial and gender discrimination - the AMA does have specific opinions in this regard (against both)...seems hard to reconcile with the "right to neglect", but it's there nonetheless. Most hospitals tend to subscribe to the AMA code of ethics and adopt very similar policies.

State and federal laws may be more specific, such as the EMTALA - Emergency Medical Treatment and Labor Act where a patient presenting to an emergency room cannot be refused treatment for any reason.

good thread.

 

[augmel]

edfig,
do you really mean that you don't like sickle cell patients and the demented? I realize the demented are maybe not fun to take care of but that sounded harsh. maybe it was just the phrasing?

 

[edinOH]

I thankfully haven't been in a situation yet where I felt like I wouldn't be able to provide care to an individual based upon their beliefs or actions/words.

But I do know that often times when I'm tired or "just don't care" at the moment I will treat a pt. "for me" rather than "for them". What I mean is that even when I am treating a pt. who obviously doesn't appreciate the care they are receiving or understand the complexity of the medical decision making that is being made on their behalf I try to appreciate the "art" of medicine and focus on the satisfaction that can be derived from knowing you did a job to the best of your abilities. It is fun to silently congratulate yourself for managing a pt. as effeciently as possible or for having a long differential or picking up the subtle details in the pts history that helped you arrive at one diagnosis vs another.

My point is that I'm usually motivated more by myself than I am motivated by the patient.

This one way to approach the above situation.

 

[edfig99]

Originally posted by augmel
edfig,
do you really mean that you don't like sickle cell patients and the demented? I realize the demented are maybe not fun to take care of but that sounded harsh. maybe it was just the phrasing?

no for me, a patient is a patient...i take no particular stance on sicklers and the demented 🙂 they all receive my excellent services, even if i have trouble...connecting with them somehow.

i was just using those as an example of patients that are identified solely by disease condition because it's a label they inherited, and you end up with a certain "picture" of this patient in your head. similar to the picture you would form in your head seeing a person covered in swastika tattoos. I mean, i sit at my nurses station, the call bell goes off..the nurse sees the room number, and goes "oh..a sickler, she wants her med." believe me, i hate it when they do that, but again, it just goes to show that personal beliefs influence care. that nurse isn't running to give pain medicine.

 

[The Pill Counter]

Timothy: I thought DocB's attending's approach was spot-on. Fact of the matter is that swastika tattoed on that guy isn't a badge of honour or pride, it's their to intimidate and threaten people that don't look like him. I think she had the right to assess the risk to herself and what she is willing to put up with. I think in the future I would handle that situation similarly.

 

[docB]

"Personally repugnant" and "dangerous" are two entirely different issues.

Not really. Usually the patients that repulse me the most are the intoxicated brawlers who are the most dangerous. Repulsion and disgust are designed o keep us out of trouble.

The question that attending of yours asked the "skinhead" is wrong

I couldn't disagree more. In one respect she was assessing the safety of the situation for herself. Second she was establishing clear boundaries. Third getting an offensive tatoo is a conscious decision designed to provoke a response. That is what it did.

On a different note:

Personal philosophies have to be checked at the door. You're gonna run into a LOT of people that you don't like and even more that are personally offensive. It's just part of the territory. Tolerance is indeed one of the most difficult things to achieve.....

Thanks, but to clarify, I've been doing this for a while. I deal with it several times per day. I was really trying to spark a discussion that might be helpful to the students.

 

[secretwave101]

I would agree that the attending made the right choice. Going to school in Israel has made me aware that symbols have power. Anyone wearing a swastica, especially tatooed, would be immediately regarded as a potential threat to most jewish doctors. A black woman could easily intrepret that symbol similarly.

Morally repugnant and dangerous are totally different things, but often are packaged together. The fact that the attending wanted to start out the relationship from a position of strength is fair. There's no way to tell how a patient will react to you, but harsh and violent symbolism gives a clue.

 

[Pgn'DocSam]

Being a physician carries significant responsibilities to our profession and by extension, the patients we serve. I once thought that I could let anything just slide off me, any weird look or epitath. In my mind, there's a a basic value to all life no matter how one may live, and that my role is to maintain and enrich that value. But my first day in the wards, that all changed. There was this little old man in the ED who I assisted in stitching. He looked as if he couldn't hurt a fly, such a kindly face and so frail, who ever could have hurt such a harmless man. But as we talked, I learned who did this to him and why. He was very blunt in his explanation, graphic in the description of the abuse he doled out on his kids and his wife for decades. The kids grew up and left, so he had only his wife to hurt, until he broke his hip and she was diagnosed with cancer, their only son came home to to take care of them both. She died and then his son did what he did to land him before me. Now I do not condone any sort of abuse, but I am a survivior of such an environment and understand the urge to seek retribution. I wanted so much to run away that moment, but realized that I am duty bound to stay. Now I face the wards with a greater deal of cynicism and my patients with a greater degree of detachment.

 

[vuillaume]

The main issue is Professionalism, and that's what the Hippocratic Oath is supposed to inculcate.

No one but the saintliest among us is going to look upon every single patient she sees with unalloyed benevolence. You're allowed to find a skinhead patient morally repugnant, or even feel a twinge of disgust with a patient with extremely poor personal hygiene.

The point is that you don't allow those visceral reactions to affect you in doing what is medically appropriate for that patient, because you're a professional, and this is the calling that you've chosen.

In fact, you have every right to think that poor, ignorant, bastard skinhead gangbanger represents the worst in humanity, but you treat him because the minute you let a moral judgement affect medical care is a future minute where you make a mistaken judgement and let someone get hurt.