A Student's Dilemma
The Racist Parent
By William McDade, M.D.,
Ph.D.
The woman was from northern Indiana and
had come to our regional medical center heralded for its expertise in
pediatric medicine. Her child was not doing well and she wanted the
best. Further, she was willing to travel into a neighborhood very much
different from her own to insure this expertise. On morning
pre-rounds, the African American fourth-year medical student entered
the infant’s room and was confronted by the child’s mother who
inquired and then accused. The medical student explained her role was
to examine the child and to learn what had transpired in his health
care overnight. She stated that she was a part of a larger team that
included the internationally famous attending physician who was
leading the teaching effort. This was unfortunately not sufficient for
the mother’s satisfaction.
She stated that she did not want any of
"your kind" touching her child. She elaborated further that
anyone who had been granted admission into medical school through
affirmative action should not be there, and that no recipient of
societal welfare is going to touch her sick child. The student was
aghast. Hurt, anger, doubt, and frustration intermingled within her.
She was devastated and now tearfully left the patient’s room. I am
not sure what must have been going through the mother’s mind at that
time. Did she feel that she had successfully protected her child from
some assault from a poorly educated black woman? Did she feel that the
debased medical student would suddenly come to her senses give up her
study of medicine through such harshly delivered discouragement? Did
she feel good about herself for having made another human being of a
different race feel bad?
The medical student, who was a
hard-working scholar and researcher, had performed wonderfully during
her 4 years of medical school. Her top university had
historically accepted few African American students per class, and
there were vanishingly few minority faculty despite the fact that the
medical center was in a predominantly minority community. Most of the
hospital staff were African American as were the vast majority of the
patients. In fact, this mother was seeking to establish a protective
circle of whiteness in a sea of cultural difference. The reality was
that there was no affirmative action program in place at the medical
school and that the student’s scores and undergraduate performance
allowed her to select from multiple offers of acceptance from medical
schools. She had done research as an undergraduate and spent all of
her summers prior to medical school engaged in a scholarly endeavor.
She was a person of diminutive stature and quiet unassuming
personality. She enjoyed her experience in pediatrics so much as a
third year medical student that she elected to do a subinternship in
pediatrics as a fourth year and was ranked among the better students
in her cohort. Her goal was to train to become a pediatric intensivist.
The student immediately reported the
events of the early morning to her senior resident and asked what she
should do for resident rounds. Her older colleague suggested that she
should describe the situation for the attending physician during
teaching rounds and ask what she should do. Meanwhile, the remainder
of the team, excluding its only African American, would examine the
child during work rounds and prepare the progress note. They would
also arrange a change in coverage so that the intern would handle that
patient as opposed to the original distribution of patients. After
all, who would want to serve a patient who insulted them so?
Life in a teaching hospital is often
complicated by requests from patients who ask for the most senior
person on the team to do the procedure or examination; but, most
understand that the presence of medical students and residents is part
of the package in coming to the university system for care.
History-taking and relatively non-invasive physical exams are
generally well-tolerated for the relative inconvenience they bring to
the inpatient experience. Some rightly think that the more minds
weighing in on their problem, the better; and many enjoy the chance to
help train the nation’s emerging physician workforce. It did not
appear that the mother had a problem with the teaching hospital
concept, because she did not prevent other physicians-in-training from
examining her child. It was clear that the single overriding issue was
race alone. Cultural intolerance was afoot here. During teaching
rounds the situation was detailed for the attending physician.
What were the options for the
attending? If she honored the patient’s mother’s wish, she would
have to exclude the fourth-year medical student from the team when
examining and discussing this patient. If she invited the African
American student into the room with the team and insisted that the
student be the primary contact with the parent as had been her
original assignment, she would run the risk of negating the parent’s
request. A final option would be to explain the nature of the teaching
hospital and the attending physician’s responsibility to educate
tuition-paying students, and to offer to help the mother secure care
at a different institution. Counterbalancing these options were: the
financial incentive the attending had for caring for a well-insured
patient; the potential referral pattern that might be disrupted if an
unsatisfied patient complained to her referring physician about her
preference rejection; and the desire to give a fearful mother comfort
during the stressful period of her child’s illness.
So, what would you have done as the
attending physician? How would you have helped the fourth-year student
deal with the doubt, rejection and humiliation she experienced? How
could you use this experience to demonstrate the impact of cultural
intolerance to the other residents and students on the team? How would
you have comforted the parent and ensured patient satisfaction?
In this case, the attending physician
chose to ask the fourth-year medical student to remain in the hallway
while the rest of the team examined and discussed the patient’s
progress. The budding pediatric intensivist was completely devastated
and sought recourse through the medical school. Fortunately, the
situation was short-lived and the patient was soon discharged;
however, the damage had been done. The humiliation, alienation, and
pain were too intense for the student. In selecting a residency
program, these events weighed heavily and caused the student to bypass
her own university in the residency matching process. She is now
successfully completing her pediatrics residency elsewhere.
However,
what message was transmitted to her colleagues in training through
their observations of their colleague’s treatment? Will they
perpetuate the behavior exhibited by their teaching-attending
physician or will they learn the irrationality and pain associated
with racism and act to confront it in their future?
William McDade, M.D., Ph.D. is chairman
of the Governing Council of the American Medical Association Minority
Affairs Consortium. He is an assistant professor at the
University of Chicago in the Department of Anesthesiology and Critical
Care and is principal investigator in a laboratory conducting research
in sickle cell disease. He is chairman of the Admissions Committee of
the Pritzker School of Medicine and is president of the Cook County
Physicians Association, and the Chicago chapter of the National
Medical Association.
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Story & Picture Source: American Medical Association
