How Should Organizations Respond to Racism Against Health Care Workers?

Abstract

This case and commentary considers how organizations should respond to overt racism expressed by patients. The article considers the nature and scope of organizations' responsibilities to train both professional and nonprofessional staff and to enact zero-tolerance policies to address expressions of discrimination. Case Dr C, an African American, is in her final year of an internal medicine residency. She reports to the emergency department to examine a middle-aged white woman injured in a car accident. The patient appears in stable condition but likely requires further medical testing. In the midst of the examination, the patient blurts out, "Isn't there another doctor who can do this? I'd rather have a white doctor." Dr C, shocked but not surprised, asks the patient if she wants the examination to continue and the patient acquiesces. The patient mutters under her breath, "I guess this is the way the world is going." Dr C pretends to ignore the comment and continues the examination. The attending staff physician is an older white male, well respected in the organization. He observes the interaction and stands by quietly, allowing the examination to be completed. Upon leaving the patient's room, the discussion among clinicians focuses exclusively on which tests are to be ordered, leaving the matter of the patient's remarks unaddressed. Commentary That racism exists in health care settings should surprise no one-it exists in all domains of contemporary life. What is surprising is just how little racism is formally addressed in medicine. 1 Noting this neglect, Johnstone and Kanitsaki ask, "Why has racism per se tended to be poorly addressed as an ethical issue in health care ethics discourse?" 2 That is a good question. We know, for instance, that there are long-standing discrepancies in health care outcomes based in part on racial discrimination. These findings are not just historical facts but reflect contemporary conditions. 3 Also well documented are racial assaults faced by health care practitioners of color, whether they be physicians, nurses, or other staff. 4 Although inequalities in access to health care services and inequalities in health outcomes deserve our utmost attention, it is racial assaults on health care staff that we wish to focus our attention on here-from an ethical perspective. We are particularly interested in exploring not only the ethical problems that emerge when

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