Wednesday, October 31, 2018

Bigotry, Medicine, and Pittsburgh

“You’re one of them wealthy people, from that wealthy family — what are they called? The Rothbergs?”

“You mean the Rothschilds?” I asked.

“Yeah they’re the ones. You’re related to them?”

“No, sir. My last name is Rothstein — different family but same religion.”

Most of the time I don’t hear about race or religion in medicine but often enough I do have interactions with patients about my religion that make me wince. In another instance I saw a patient after a large surgery. I introduced myself and asked him how he was doing. “I’m okay,” he responded. Then, after a pregnant pause, he looked at my ID badge, then my face, and asked, “You’re Jewish, right?”

“Yes, I am,” I responded.

“I have great respect for the Jewish people. You know Jesus was Jewish, right?”

“Yes, I did know that.”

“But you don’t believe Jesus was the Messiah, right? You know, Jesus is our Lord and Savior and he performed incredible miracles while he was alive. Did you know that?”

“Yes, I’ve read some of the New Testament and I’ve spoken with Christians about their beliefs.”

“Well, then, why not believe in Jesus? He built on Judaism. His thinking revolutionized religion. It is the latest prophecy, the latest and truest Word of God. Would you be interested in seeking out Jesus?”

“I appreciate the offer but I’m comfortable with my own religion.”

“Well, you should convert. It’s the only way to seek the real Truth. Jesus is the Messiah and if you don’t convert you won’t be going to heaven.”

“Thanks, but I’m okay. Now, how’s your surgical site doing? Are you still in any pain?”

Sometimes it even goes beyond this. There was a patient I saw regularly in the hospital who would intermittently get aggressive, annoyed, or anxious. The nurses called me to talk him down. One evening he was particularly upset about being in the hospital. I entered his room as the nurse was leaving. “Tell that n***er to leave me alone!” he shouted.

“Excuse me, that is inappropriate. We do not use that kind of language.”

He looked at my name badge and shouted, “Well guess what? I’m Hitler, so I think you should leave.”

This is not to mention a co-resident who was told by a patient, “You’re such a Jew.” Or another patient who told a Jewish co-resident, “All you want from me is a pound of flesh” — a reference to The Merchant of Venice, where Shylock, a Jew, lends money to a Christian and demands a pound of his flesh as security.

These experiences and others I’ve had run the range from threats of violence to humorous to uncomfortable, but there is a theme behind them. Unfortunately, my experiences are not unique. All physicians take care of racist or bigoted patients. In January 2018, the Wall Street Journal published a piece on racist patients, quoting doctors discussing their experiences. In a 2017 blog post by the American Academy of Family Physicians, multiple physicians retold their stories of interacting with bigoted patients. Dr. Lachelle Dawn Weeks, a resident at Brigham and Women’s Hospital in Boston, wrote a short 2017 essay for STAT News chronicling her experience with racism. She concludes that

in an ideal world, hospitals would categorically disavow cultural and religious discrimination. Hospital administrators would publicly refuse to cater to culturally biased demands and express a lack of tolerance for derogatory comments towards physicians and staff as a part of patient non-discrimination policies.

Dr. Dorothy Novick, a pediatrician, wrote in a 2017 Washington Post op-ed that “When I treat racist patients but fail to adequately address the effect of their words and actions on my colleagues, I not only avoid teachable moments; I condone hate.” Dr. Farah Khan wrote in 2015 in The Daily Beast, denouncing bigotry she’s faced in the hospital. She asserts, “We should be taking strides within the medical community to break down unfair judgments and racist ideals.” Moreover, “Of all the things that I had imagined brown could do for me, I never really expected it to make me feel out of place both inside and outside of the hospital.”

These interactions do make a physician’s job difficult. Patients refuse treatment from a particular physician or verbally abuse him or her on the basis of race or religion. A physician cannot offer an argument against this to assuage the patient. And it is difficult to hear or experience these insults and epithets after years of training to help others.

What, then, ought to be done? Many of the physicians I cited above offer condemnation and resolve not to tolerate racist behavior. But in practicality these are non-specific, anodyne proposals. Of course hospitals, and we, should condemn such behaviors. But what does that mean in terms of our conduct in the hospital?

In an earlier post, I’ve written about the more general difficulties physicians regularly experience because of frustrated patients, who may swear at, insult, or even slap us, and since writing those words I’ve been punched or swung at by patients multiple times. I’ve been accused of not caring about my patients, of being a bad physician. This is part of the difficulty of the profession. Physicians and nurses bear the brunt of patients’ frustrations or hatred. And while we can tell patients that their language is inappropriate, part of being a physician is offering our services when they are ill, despite how we might feel about them or they might feel about us.

This is nowhere more true than during war. As I’ve previously written about the role of the Hippocratic Oath in wartime, “The physician ... is responsible only for the good of the patient no matter what uniform that patient may wear. The Oath makes no exception for wartime or for the treatment of an enemy.”

Tree of Life synagogue in Pittsburgh / CTO HENRY (Creative Commons)
One of the most recent and heartening examples of such principled medical practice was after the attack in Pittsburgh this past week, where an anti-Semitic gunman killed 11 Jews in a synagogue, screaming “All Jews must die.” After being injured in a gunfight with police officers, the gunman arrived at a hospital where Jewish doctors and nurses took care of him.

Yes, there are bigots and racists who not only insult those who are different but murder them. However, in the face of such hatred we must continue to offer the patient treatment. To treat patients in their time of acute need despite what they’ve done or said is part of our professional responsibility.

This may strike some as a deeply unsatisfying conclusion. Where is justice? Where is the punishment for these people? Why shouldn’t they face consequences for their hatred? But we see these patients for a brief moment in their lives. Distributing punishment is not our purpose, nor will a refusal to treat them change the way they feel or act. In fact, a physician is far more likely to change such behavior and to make an impact by treating the patient. After that, we trust our legal system to distribute punishment, and hope the prejudiced patients figure the rest out themselves.