Opinion: What's the prescription for a hateful patient? Connecticut doctor asks

Pranay Sinha of Hamden is in his third year of residency in internal medicine at Yale-New Haven Hospital.

By Pranay Sinha, MD

Los Angeles Times

December 8, 2016

I have been appalled by the swastikas, homophobic propaganda and lynching references mushrooming across the country, but the danger felt theoretical until recently, when I became a victim of hate speech from a patient.

My patient's kidneys were failing and we needed to know why. After wheeling, dealing and pleading, my intern and I persuaded the MRI techs to do one last scan before they went home for the weekend. My heart beating triumphantly, I raced to update the patient.

To be honest, I was dreading the conversation as he was a certified curmudgeon, but I felt relieved when I found him prattling pleasantly with some nurses. As I told him about the upcoming scan, he exploded.

Health care workers soothe frustrated and frightened patients every single day. This was different.

Thrusting his finger in my face, he screamed, "Your kind are so disorganized. You should have figured out that I needed the MRI hours ago. I'm gonna get you fired."

His words cut to the quick. There was little question that I was being addressed differently because of my brown skin and beard.

Though cantankerous, he had been civil with my white colleagues. My blood pooled in my legs. I felt dizzy with rage. In a poorly constrained growl, I explained that he was in danger, that I was doing my best to take care of him and that he needed to reciprocate the respect that we were giving him. He replied that he had shown me ample respect by letting me speak to him in the first place.

Unwilling to continue the conversation, I silently helped wheel him to the MRI and left the second my services became unnecessary. I was seething within.

Could he not see how hard I was working for his benefit? Is my humanity subservient to my identity as a physician?

Health care workers cannot simply walk away from sick patients even if they spew hateful words. Duty is duty, but we also cannot allow ourselves to be degraded. Ask any physician of color and you will probably hear stories worse than mine. In recent weeks, my colleagues and I have noticed an uptick in hate speech. Some patients have refused to let doctors and other health care workers of color touch them, commanded us to leave the country and accused us of terrorism. As someone here from India with a work visa and hopes of getting a green card, these are unsettling incidents.

Most often, we respond to hate speech with avoidance or even appeasement. Reliance on patient-satisfaction scores for compensation can force abused health care providers to tolerate hateful words.

In the past, I have shrugged off casual racism a number of times to preserve a therapeutic relationship. There was the time a patient asked me to "speak in English" because of my Indian accent and the time another patient asked me to fetch him curry. I convinced myself that I was being "professional" by being thick-skinned.

The skins of health care workers are thickened by social, financial and legal security. I worry that the same hateful words that glance off my thick skin will go on to hurt a more vulnerable person — a recent South Asian immigrant working at minimum wage, for example. By signaling that it is OK to address minorities with hateful words, we leave the most vulnerable among us open to attack. Part of me still feels embarrassed at having lost my cool with my patient, but I am also glad that I let him know that his verbal abuse will not be left unchallenged.

In a time when white nationalists are holding meetings openly in a federal building, hate speech is inescapable in the hospital. Trainees should be prepared to navigate these challenges. Senior physicians and nurses have an important role to play. They must express solidarity and teach younger colleagues like me what to say, what to do and where to draw the line. Above all, we need to dispense with the notion that enduring sexist, racist or homophobic slurs silently is an element of professionalism.

The day after my patient threatened to have me fired, I had to return to work and resume caring for him. I did my best to respect his humanity and, although still grumpy, he remained civil. I pray that compassion and empathy prove to be the antidotes for prejudice.

Pranay Sinha of Hamden, Conn.,  is in his third year of residency in internal medicine at Yale-New Haven Hospital. This piece originally appeared in the Hartford Courant.