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Honoring diversity when patients act on racist beliefs

Esther Choo, M.D., M.P.H.
Esther Choo, M.D., M.P.H., Associate Professor, Department of Emergency Medicine, OHSU School of Medicine. (OHSU/Kristyna Wentz-Graff)

In the immediate aftermath of the white supremacist rally in Charlottesville last weekend, I shared a personal story on Twitter about encountering racist patients in the emergency department. The thread generated a flood of responses from other health care providers who have had similar experiences. I quickly realized how common these experiences are, how people don’t feel that they can talk about them, and how deeply these experiences can erode morale.

Like me, many health care professionals have considered prejudice or racism to be a frequent, almost routine part of their jobs. Some said they felt powerless to even mention that they experience racism from patients or staff members. Some felt that their performance evaluations or positions might be at risk if they spoke up. Others have been witnesses to, rather than targets of, bigotry and struggled with the appropriate way to respond and support their colleagues.

Judging purely by my observation of the dialogue that followed my Twitter thread, I believe health care needs to improve our response to racism against our clinicians in several ways.

1. We must be prepared to speak up when we see racism.

Silence is as damaging as engaging in hurtful speech – in the silence, the student or physician experiencing the bigotry must wonder if you share the patient’s viewpoint; if you dissent but respect it; if you are completely oblivious to it; or if you are disgusted but too timid to speak up. Those of us in positions to set an example and drive the tone of a patient encounter, a learning experience, or entire departments or organizations, cannot fail to respond to moments in which patients or other staff members express overt racism.

2. We must lower the bar to divulge experiences of racism in the health care workforce.

In order for incidents to be addressed, they must be brought to the attention of others, and this is not an easy thing. My social media thread was one of the first times I have ever really spoken of these events. The outpouring of recognition from other health care providers reminded me of the release after incising an abscess: there were toxic experiences festering within people, and they had never been given egress before.

3. We must provide more support for providers who experience racism.

Being the target of racism is painful and embarrassing: health care workers describe feeling humiliated, ashamed, angry, depressed and frightened. Leaders in health care enterprises must establish clear, visible policies stating zero tolerance for discrimination against anyone on campus (such as the one at Oregon Health & Science University Hospital). They should also anticipate that such incidents will invariably occur, that they may be traumatic for the providers, and provide opportunities for debriefing and counseling afterwards.

I am now solidly in the mid-phase of my career. It is easier for me to react to negative incidents with equanimity. I look back at my younger self, gingerly making my way through medical school and training, and breathe a sigh of relief that the landmines of gender and color did not obscure my path. Nevertheless, my status as a woman and a racial minority affects my experience in the hospital every day.

I’ve been deeply moved by the response to my thread this week. The events at Charlottesville created the space for people to express their well of experiences and feel empowered to speak up about them. I feel we can do so much better for our colleagues in medicine who experience racism daily, and if we do, I’m convinced this will translate into a stronger health care system, and better health care for all.

Esther Choo, M.D., M.P.H. is an associate professor in the OHSU Department of Emergency Medicine, and is part of the OHSU Center for Policy & Research in Emergency Medicine.


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