Diane Thomas, Managing Editor
December 1, 2020
This past July, Harvard Medical School’s Postgraduate Medical Education team (PGME) launched a webinar series titled: Addressing Health Disparities: Clinical Insights on Race and Social Justice, which seeks to explore how race and racism affect the health of our communities. The following post is an excerpt from a session in which Dr. Sachin H. Jain discusses his paper “The Racist Patient” in the Annals of Internal Medicine with Dr. Kevin Tucker, faculty director of Accredited Programs for PGME:
KEVIN TUCKER: So, when we started thinking about this webinar series, you immediately came to mind as one of the people whom I thought we should talk to because I remember the essay that you had published in the Annals of Internal Medicine going back to 2013.
And in that essay, you talk about an unpleasant experience that you had with a patient that highlights some of the issues about dealing with a patient who is racist. So, I want you to walk us back and tell us a little bit about that experience and about your writing about it. So just tell us a little about that.
SACHIN JAIN: Yeah. It was it was January 2012. I was a senior resident at Internal Medicine at the Brigham and Women’s Hospital. And I was called by my intern at the time who said, “There’s a very difficult patient who’s very upset, and would you mind coming and speaking with him?”
Went to the patient’s bedside, asked the intern what was going on. And she said the patient’s insulin wasn’t necessarily available through our pharmacy. And there were we were planning on offering an alternate form of insulin, and the patient only wanted to use their type of insulin.
And at that point, I asked the patient if they would be interested in bringing in their own insulin. They continued to be upset, and the conversation escalated a bit. And at some point, the patient launched a pretty significant missile in my direction. The patient said, “Why don’t you go back to India?”
And I’m actually from Bergen County, New Jersey. I’m Indian origin. And it was the first time in my years as a medical student or as a resident where I had experienced racism. I’d experienced, I would say, subtle forms of racism. But this was basically a racial epithet being hurled in my direction in a professional context, and it caught me completely off guard. I had never imagined that I would experience that wearing a white coat, having gone to the schools I attended, being in the position I was of trying to help this individual get the insulin that they needed. And almost reflexively, and regrettably, on the spot, I told the patient, why don’t they get the bleep out of the hospital?
And I then had this crisis of conscience about what I had done, how I was feeling in that particular moment. I felt like I had potentially violated some of medicine’s unstated professional norms. At the same time, I was, frankly, appalled that that type of behavior not only took place. I was just one person who’d experienced it, but there are countless people who’d experienced those types of attacks by patients.
But I was also kind of curious about the complete lack of institutional response around the issue. I, of course, notified my resident, notified my attending, rather, at the time. We transferred the care of the patient to a different resident. Or, I think what happened was that the intern actually just managed the patient directly with the attending, and I was out of the way, largely.
So, I actually put pen to paper and wrote about this experience. And I had the experience of then sending it to a number of major medical journals and having it be rejected as being non-topical, irrelevant. My response didn’t reflect the values of the profession, that type of thing came back in the reviews. And then I give Christine Laine at Annals of Internal Medicine a lot of credit. She published the piece, I think, against the recommendation of some of the reviewers.
And the paper ended up causing a lot of controversy. I got a number of letters saying I need to learn a bit about how to be a doctor, that my teachers hadn’t taught me how to be a doctor, because I had reacted negatively to this patient in the way that I had. And to be clear, I certainly regret the response. But it was also a human response.
And I think what was jarring to me about some of the responses to my essay were that professionalism was equated with stripping me of my own humanity and my own reaction to things. And I would say the second piece of it was I got a number of responses, an overwhelming number of responses, from minority physicians who were basically saying, thank you. Thank you for putting into words what we experience every single day.
And I heard just a number of heart-wrenching stories, stories about medical students at Mass General being reassigned to other patients because the patient didn’t want an African-American medical student taking care of them. I heard about physicians in Memphis, Tennessee who endured racism every day. And despite their pleas to medical staff leadership to do something about it, there was a desire to maintain, you know, Press Ganey scores at high levels. And so there was a desire to not necessarily address that for fear of a lower set of patient satisfaction scores.
And so I thought, we have this really messed up society in which the people who are empowered to take care of others are totally unprotected from abuse. And what’s been really remarkable to me in the midst of everything that’s been happening over the last decade, almost decade since that event happened, is that the conversation around this has completely shifted.
And it’s been heartening and it’s been heartwarming, because I think we’re arriving now at a place where the profession in 2020 no longer accepts abuse as part of being a so-called professional. And so, I think we’re at an incredible inflection point. But we have a long way to go, I think, to really support health care workers.
And I really mean health care workers at all levels. I mean, I think it struck me as being particularly appalling as a physician, but I can only imagine what the patient care attendants and RNs who are at the bedside experience every single day in the course of their much more intensive interactions with patients in the course of caring for them. So I think that we have an opportunity to reset the culture of our profession, and that’s why I’m really thrilled to be here with you today in this webinar.
View the rest of this discussion about how racism affects health care, how things are changing, and what work still needs to be done by clicking on this link: The Racist Patient. CME credit is available until January 2021.