Discrimination Against Patients by Healthcare Providers

Recently, I was speaking to a nurse (whose identity will remain anonymous for her sake) regarding President Donald Trump's travel ban on seven Muslim majority countries. This nurse is an immigrant from another country and has been working in the United States for roughly 30 years.

This nurse expressed her support for the travel ban against Muslims, saying that it's "for the better". Her support was not based on any fear of terrorists. She stated that having been a nurse for 30 years, she's encountered a number of people who come to America and "mooch" off the system. With regards to the seven banned countries, she stated that she's had a number of "birth tourist" patients whose purpose is to give birth to American citizen babies and take advantage of the system. She described the patients as "demanding", "knowledgeable of the system", and not knowing how to speak English. In her opinion, banning Muslims would prevent these "birth tourists" from entering the United States and stealing our tax dollars and free money given away by hospitals.

Obviously, I questioned the logic of her arguments, specifically the "free money" given away by hospitals (because that would make my job so much easier) and the "birth tourists" being mostly from Muslim countries. Her response is that she's been a nurse for 30 years and I've only been a social worker for 7 years, therefore she knows more about social services than I do. I promptly ended my discussion, as I knew it was not going to get anywhere.

There were a number of things that bothered me about my conversation with this nurse, but I for the sake of this post I will focus on one. What really bugged me is that this nurse works for a hospital in one of the most socioeconomically diverse places in the United States. If this nurse has such views of Muslim immigrants in general being demanding and out to take advantage of the system, then how does this affect how she cares of them?

Reflecting on my limited 7 years experience in the social work field, I have observed numerous instances of both overt and veiled discrimination in the hospital setting. Here are some examples:

• Nurses complaining about having "another African-American/Mexican/Middle Eastern/Medicaid/non-English speaking/etc." patient. This is not limited to Caucasian nurses. Knowing a second language, I have heard the same complaints from nurses speaking to each other in their native language in the break room.
• Patients with too many questions or requests being labeled "demanding" during morning rounds. At times, I've been sent in to talk to families because doctors "don't want to deal with them anymore".
• Complete scorn for families not wanting their loved ones to enter hospice care due to cultural or religious reasons.
• Healthcare providers attributing their problem patient's behavior to ethnicity or culture.

I realize that when it comes to challenging patients, there is going to be some grey area. Perhaps that "demanding" patient is indeed a narcotics addict hopping emergency rooms for more meds. Maybe that nurse is being treated like a personal servant by her patient. Abuse of hospital staff happens all the time.

However, the patients we see represent a small fraction of the entire population. It's certainly easy allow frustrating patients to reinforce our personal prejudices, but we must remind ourselves that one person should not represent an entire culture. Our patients come to the hospital because they need help, and otherwise would not be there if they didn't have any problems.

My social work education emphasized the need to check our biases at the door so we can provide optimal care to our clients or patients. While I hope that non-social work healthcare workers do the same thing, a study by the Agency of Healthcare Research and Quality reflects the following:

• Blacks and AI/ANs received worse care than Whites for about 40% of measures.
• Asians received worse care than Whites for about 20% of measures.
• Hispanics received worse care than non-Hispanic Whites for about 60% of core measures.
• Poor people received worse care than high-income people for about 80% of core measures.

As healthcare providers, we are in this field to help all people. I will not deny that our jobs are emotionally draining, physically taxing, and often thankless. However, if we healthcare providers cherry pick who we are able to provide quality, compassionate care to, then what does this say about our society as a whole? As the cliché goes, we are a reflection of how we treat our most vulnerable populations.