Dropping the R-Bomb

I was called a racist a couple of days ago. The patient was upset, there was a slight delay in getting a bed, and the patient perceived our care was subject to some sort of a racial screen. Or else chose to make that argument. There was a lot of yelling and screaming in the waiting room: “You’re a bunch of racist pigs”, and then to me, “When you see a black person, you see dirt, don’t you?”

The patient was brought in, appropriately, and later signed out Against Medical Advice, because the lab was too slow with the blood results — more evidence, I suppose, of the racism of Canadian health care and the bigotry of the nursing staff, including myself.

It was ugly and stressful for everyone.

It is always a source of amusement to me that behaviour that wouldn’t be tolerated in, say, a bank or a grocery store is deemed to be perfectly acceptable in a health care setting. We have a duty to care, even if they are idiots. And further, the College of Nurses, the nursing regulatory body, virtually demands nurses establish therapeutic communication even with clearly out-of-control, manipulative and irrational patients to determine the source of their discontent and rage, and then tends to blame us when we can’t.

At the bank they call the police. In the Emergency Department we reward bad behaviour by expediting care and getting the patient out of our faces by quick dispositions.

It is, in fact, hugely disruptive to the entire department when the word “racism” is used. We — the nurses and physicians — tend to circle the wagons, because one unsubstantiated charge of racism can lead to a whole world of trouble, tens of thousands of dollars in legal costs, and a blemish on one’s professional record. The only possible defence is documentation, charting by the yard. Of course this delays care for everyone, including for the person who used the word. I spent at least an hour myself documenting, and ensuring everyone else documented as necessary as well — not an inconsiderable amount of time if you’re a charge nurse — and this meant because I was occupied doing the uselessly needful, the entire department operated less efficiently.

The registration clerk, who is South Asian, and who witnessed the whole nasty scene, was deeply and visibly angered. “Racism does exist,” said the clerk. “And people like that patient just trivialize the whole issue.”

Exactly.

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  1. #1 by JennJilks on Friday 28 May 2010 - 1315

    You have to know that this patient was operating from fear, not anger. If only s/he read your blog. They’d know how hard you work and patients need to have patience, speed isn’t always the best first response, nor quick diagnoses.
    There is a good sign for your triage/reception desk:

    Patients are requests to have patience! Staff members are only human.

    • #2 by torontoemerg on Friday 28 May 2010 - 1531

      Thanks, Jenn, though I’m not clear about this particular patient — there was an obvious chip on the shoulder from the get go, and the presenting complaint was relatively minor — though if I were to make a generalization, I would say this would be true. I’m usually much more, um, tolerant of waiting room silliness.

  2. #3 by wilomis on Saturday 29 May 2010 - 2142

    Unfortunately those who claim others are guilty of racism are typically practicing racists themselves. Most often the place people go first is the place they know best, themselves. Sorry to hear it.

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