Racial profiling... By patients!

The other day, I walked into the cath lab for my third case of the day.  The patient was a 60 something Filipino guy who came in with chest pain, ECG changes and had positive cardiac enzymes.  So basically he had a mild heart attack.  And given his symptoms and other tests, he probably had some serious blockages and needed this angiogram relatively urgently. He was a clinic patient, seen by one of our fellows in the hospital.  The patients we see in clinic during our medical training as residents and fellows are usually those without insurance or those with some sort of medicaid.  Treating these patients is usually both challenging and rewarding.  They are often quite sick and come from poorer communities with poor access to health care and often have multiple medical issues, not to mention usually less educated and sometimes with poor insight to their diseases, and often English is their second language.  However these patients are very grateful for the care we provide them.  Always treating the physicians with respect, trusting their decisions, and wil usually do everything in their power to follow instructions.  I prefer this type of patient rather than the ones from middle to upper class communities, who are usually not as sick, but come armed with all sorts of questions and concerns from their google searches and newspaper articles and often times can drive you nuts! It is good to be educated and have questions, however there is a limit to what you learn from a google search and some newspaper article, compared to what years and years of medical training and experience provide.  In many cases medicine becomes more of an art rather than science, and weighing risks and benefits of different strategies.  But anyhows, I digress.. Back to the cath lab table...

So I walk in, put on my lead apron, and introduce myself to the patient like I always do.  He is on the table, the equipment is being opened and we are getting prepped.  Once I introduce myself he stares at me and speaks in a sort of strange monotone voice, with a little accent but with pretty good English. He asks are you doing the procedure?  I told him yes, I will be working with Dr. T and we will be doing the procedure. He seems concerned and says he was told a different doctor was going to be doing it.  We asked him who he expected, but he could not provide a name.  He said the doctor was going to speak to him before hand, and kept making excuses.  Finally as I step away to get gowned up, the nurse asks him, listen do you want to cancel the procedure?  And he says yes.  I don't want to go through with this.  I told my attending and he said fine forget it, he wants to cancel, let him cancel.  

So later in the holding area, apparently the nurses were trying to figure out what happened.  Finally a filipino nurse went to speak to him, and he said that he does not want an Indian or "brown" doctor doing his procedure.  He only wants a white doctor. So he cancelled once he saw my face.....  Wow!  Seriously?  I must say , that is a first for me.  Doing all my training in the new york area, I have never encountered that situation!  Especially since there are so many different ethnic groups that make up both patients AND doctors.  If you don't want a brown doctor, then NYC isn't the place for you!  Because half of them are brown!  And the craziest thing was, that this guy was Filipino!  I mean maybe I could have understood if he was some 80 year old rich white Jewish guy from the upper east side of manhattan, but a Filipino clinic patient from queens?  Wow.  I must say it really annoyed me.  Franky I wanted nothing to do with him after that.  We are trying to help you and potentially save your life, and you refuse on the table because the doctor was of brown skin. Amazing!

Anyway, the team called me later saying the patient was apologizing and could we still do the procedure if he was agreeable?  I said I am going to have no part of this, speak to the attending.  And if you critciize me for not wanting to be a part of it, then give me a good reason.  Because if the patient does not want me or people of my color treating him, why should I?  To me that means he doesnt want my help and if something goes wrong hes more likely to sue.  We should not condone such things and we have no obligations to in my opinion.  We were going to discharge the patient home after that since he refused.  Eventually either his family talked ot him or something happened, and we decided to do it. I was not involved in the case.  My attending reluctantly agreed, and we put in the other fellow (the white fellow) to do the case with him. .  The cath basically showed the worst possible blockage ever, a 95% blockage in the left main artery (the main tree trunk artery supplying all the blood vessels), and a 95% blockage in all 3 of the arteries that come off it, all that were calcified and hard as a rock. Frankly I don't know how the guy is alive, he really should be dead with this anatomy! Somehow he is walking around with this!  So we refer him to the surgeons because doing a stent on this is not recommended and high risk.  The surgeon who we sent to him was a Persian and so was his fellow! Hah.... And the latest I heard, the guy is now refusing surgery...

 

 

Comments

[Abe Arhin]

I found your blog today while googling cardiology fellowships and I'm very sorry you had to deal with this. As a black male medical student my only fear is having to deal with isssues like this once I graduate. I hope it doesn't happen but people will be people. I just want to say I really appreciate your blog. Please I know you are busy but if you can it will be really helpful if you would consider doing a guide for a US medical student who aspires to a profession in cardiology. Losing my Dad to an M.I. got me to apply to medical school and interested in cardiology. I would appreciate any guidance or advice you could offer me as you have been through it all and are now in the promised land we medical students cannot even see from afar yet. Also any books, websites you think will help give me the exposure or knowledge I need so I can start planning early? My email is also listed . thanks so much for doing this.

[adiland]

its really a tough job, to operate the heart surgery, only doctors have the courage to do this job. Hats off to them.
SMI SOFT