The rights of patients vs. hospital employees

As doctors, our job is to do the best for our patients. We may not always like them or their opinions, but we have to learn to work around it, or refer them to someone who can.

A few years ago, a medical resident came to me after seeing a patient.

Courtesy of Peter A Lipson
Courtesy of Peter A. Lipson.

“The patient wants to see an American doctor,” she said.

I have no idea what was going through the patient's head. When people are sick, they are vulnerable, scared. Perhaps her mild accent put him off. Or maybe he came in looking for a fight. Who knows?

Not long ago I was talking to an elderly retired surgeon. He was one of the first black trauma surgeons in the area and at the top of his field. He said he would regularly walk into a trauma bay to have an African-American patient say, “Get your black hands off me and get me a white doctor!”

Maybe patients felt that white patients always got better care, care that was usually delivered by white doctors, and they didn't want to be denied that care. Or maybe they were just cranky. Who knows?

We all have certain images of who we expect our doctor to be, and we all have our prejudices. As doctors, our job is to do the best for our patients. We may not always like them or their opinions, but we have to learn to work around it, and if we can't, we have to refer them to someone who can.

Given that our duty is to serve our patients, how should we respond to requests like this? Recently, not too far from me, a man allegedly requested that no black nurses care for his newborn. This would have put the hospital staff in an uncomfortable position. I would hope that in a similar situation I would act in a way to preserve the dignity of my patient and the staff. Or I could get it completely wrong, as the hospital allegedly did, and reassign non-white nurses.

But why shouldn't patients be allowed to choose who cares for them?

There are ethical and practical problems that I'd like you to think through with me.

Hospital patients often cannot choose to simply pick up and go to another hospital. It may jeopardize their health and put them in danger. The hospital has the responsibility to give patients the best care it can and to respect their dignity and autonomy as much as is practical.

But this doesn't mean a hospital must fulfill every request. A patient may insist on more narcotic medications, and the doctor may think it unwise. Here, the responsibility of the doctor is to explain to the patient why he or she thinks it would be in the patient's best interest to avoid narcotics. The key to preserving the dignity and autonomy of the patient is informed consent. Patients must be given sufficient information to make good decisions.

But hospitals also have responsibilities to their employees. For example, they must provide a safe workplace. In this case, the hospital, by allegedly acceding to the man's request, attacked the dignity of the nurse. If a patient had complained that a particular nurse wasn't, for example, washing her hands, then the hospital should investigate this for the good of the patient. But there is no rational argument that a nurse's skin color is harming a patient. Since it does not degrade patient care, and it diminishes the rights and dignity of the nurse, such a request should have been denied.

A patient who makes such a request should be told, without judgment, that his or her request cannot be met. It would then be up to the patient to decide what to do. In the case of a minor, the hospital must also think of the young patient. If a parent intends to walk out before the baby is ready because of the race of the nurse, the answer isn't to pull out the nurse but to call the proper child protective authorities.

I'm not saying these decisions are easy; it's far too easy to give into our emotions, to tell patients like these what you really think of their requests. But that would only fulfill your own desire to be heard, rather than the patients' and staff's needs.

It's also easy to run roughshod over the staff's rights to keep patients happy. But it's not right.