AUGUST 28, 2019 Timothy M. Smith Senior News Writer American Medical Association
In the current sociopolitical climate, it’s not
uncommon for physicians and other health professionals— especially those of
color—to be subjected to racist behavior by patients. In the absence of a
proactive, principled and coordinated response, the ramifications can be
serious and lasting for individuals and toxic to organizational culture. Two
social work experts suggest several key actions for leadership to take.
Following are highlights from an article published in
the AMA Journal of Ethics® (@JournalofEthics) by Ann Marie Garran, PhD,
associate professor and director of the Master of Social Work Program at
University of Connecticut, Hartford, and Brian M. Rasmussen, PhD, associate
professor in the School of Social Work at the University of British Columbia’s Okanagan
Campus.
Using a case of an African American resident
facing bigotry from her patient and subsequent inaction by her attending
physician, the commentary looks at the nature and scope of organizations’
responsibilities to address and prevent expressions of discrimination.
“That racism exists in health care settings
should surprise no one—it exists in all domains of contemporary life,” the
authors wrote. “What is surprising is just how little racism is formally
addressed in medicine.”
They recommend these five responses.
Don’t pretend the racism doesn’t exist. How the ethical dilemmas posed by racism
are resolved has not been extensively researched. Nevertheless, organizations
“must first move beyond the current state of discrimination against clinicians
being an ‘open secret,’ and they must acknowledge that reassignment requests
motivated by bigotry are problematic and can, in fact, do harm,” the authors
wrote.
Recognize racism’s many manifestations and their
effects. Not all racist
expressions are overt, the authors warned. Even microaggressions—slights and
other subtle attempts to demean, marginalize or “otherize”—can cause physicians
and other health professionals to feel personally and professionally
disrespected.
Define zero tolerance. “Given the ethical (and legal, in some cases)
demands to provide care and not to treat patients against their wishes, zero
tolerance does not mean letting expressions of discrimination slide. It does
mean acknowledging what was said and addressing the racist behavior,” the
authors wrote. “What is required is the capacity, skill and willingness to hold
these difficult conversations and actually enforce, not just advertise,
organizational policies.”
Encourage white supervisors to step up. Physicians of color are hesitant to report
experiences of racial discrimination to white supervisors, the authors noted.
They said this can be attributed to “white fragility,” in which racial stress
causes the supervisor to respond defensively, leaving the physician of color
feeling she has nowhere to turn. Health care administrators should lean into
their roles as leaders to raise awareness of and combat this phenomenon.
Take it to your leaders. “Organizational leadership and support are
key if institutions are to truly fulfill an antiracist mission, but that
leadership and support require a firm commitment from all stakeholders in the
organization,” the authors wrote. In fact, periodic trainings in cultural
competence or diversity will “do little, if anything, to address racism, power
and privilege on the interpersonal or institutional levels in the absence of
concerted, ongoing organizational commitment.”
The June 2019 issue of
the AMA Journal of Ethics features numerous perspectives on
the ethics of establishing limits to patient preferences. It also gives you an
opportunity to earn CME credit.
The AMA Council on Ethical and Judicial Affairs is
reviewing existing guidance on disruptive behavior by patients in light of
increasing reports of incidents in which patients discriminate against
physicians.
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