Case Summary
William Joseph, a 63-year-old man, presents to the clinic for a follow-up appointment to review his laboratory test results. Mr. Joseph is usually seen by Dr. Clark, who is currently absent due to a personal emergency. Therefore, Mr. Joseph is referred to nurse practitioner (NP) Yang Shi, who will oversee the patient instead of Dr. Clark.
As Yang Shi enters the exam room and presents himself to the patient, Mr. Joseph claims that he is not willing to work with the professional and is required to meet Dr. Clark as usual. NP asks the patient if there is anything that he has done wrong, so the patient does not interact with him. Mr. Clark allows himself a set of racist statements underlying the fact that he is not willing to interact with Asians specifically. The patient expressed his dissatisfaction with the racial identity of the NP, pointing to it as a critical reason for his rejection of interacting with the NP. As a result, Yang Shi decided to leave the exam room and consult with the clinical manager regarding the situation.
Potential Impact
Discriminatory behavior towards healthcare providers can have a profoundly negative impact on the client-provider relationship. NPs can experience harm to their dignity and reduced motivation to provide a patient with the care required. Vaismoradi et al. (2022) state that racist behavior toward nurses can cause “emotional trauma and enhances job-related stress among nurses, leading to their turnover.”
Maharaj et al. (2021) underline the broader impacts of racist patient behaviors. The researchers note that discriminatory behavior can lead to the reinforcement of structural racism, including “discriminatory beliefs, values, and distribution of resources” (Maharaj et al., 2021, p. 40). Ignoring the situation can result in the dissemination of discriminatory beliefs among patients and other healthcare providers, which can increase potential race disparities.
Techniques to Enhance Communication
The episode of discriminatory behavior reveals broader issues of racism in the healthcare setting. Shim and Starks (2021) report that the COVID-19 pandemic has contributed to the increase in racial bias and the presence of structural racism related to it. Some patients may express their concerns about the role of people of Asian origin in the events, which leads to prejudice and discriminatory behavior. Shi et al. (2022) report that “the associations of racial discrimination with mental or behavioral health were most salient among Black, East Asian, Southeast Asian, and Hispanic respondents” (p. 2501). Therefore, those racial groups were subject to increased racial bias during the pandemic.
In the case of Mr. Joseph and NP Yang Shi, organizational leadership plays a key role in eliminating the negative impacts of the episode and reinforcing anti-racism efforts (Massaquoi, 2023). Hassen et al. (2021) emphasize that implementing anti-racism policies is a crucial step in addressing the issue. Such policies should also include training and education of healthcare providers to deal with the situations of racist behavior on the part of patients.
To address the problem and facilitate communication with the patient, the NP should bring the clinical manager to discuss the behavior with Mr. Joseph. Clinical managers should explain that such behavior is not tolerated by healthcare facilities, which can support anti-racism policies. The manager should underline that healthcare providers can refuse to provide care for patients due to policies based on their discriminatory behaviors.
Sample Documentation
The documentation of the encounter should be clear and concise. It should involve the description of the location, time, people present, and the exact words of the patient leading to the incident (Bickley, 2020).
Sample documentation:
“September 22, 2023. William Joseph is a 63-year-old male presenting in the clinic for a follow-up on the results of his laboratory tests. Mr. Joseph is usually seen by Dr. Clark, who was absent on the day. Mr. Joseph was informed about it and referred to NP Yang Shi. As the NP entered the room and introduced himself, the patient said, “I am not talking to Asians. Where is Mr. Clark?” Reported the incident to the clinical manager. Discussed zero-tolerance policies with the patient.”
References
Bickley, L. S. (2020). Bates’ guide to physical examination and history taking (13th ed.). Wolters Kluwer Health.
Hassen, N., Lofters, A., Michael, S., Mall, A., Pinto, A. D., & Rackal, J. (2021). Implementing anti-racism interventions in healthcare settings: A scoping review. International Journal of Environmental Research and Public Health, 18(6).
Maharaj, A. S., Bhatt, N. V., & Gentile, J. P. (2021). Bringing it in the room: Addressing the impact of racism on the therapeutic alliance. Innovations in Clinical Neuroscience, 18(7-9), 39-43.
Massaquoi, N. (2023). Racial humility over competence: Addressing anti-Black racism and healthcare leadership responsibility. Healthcare Management Forum, 36(5), 280-284.
Shi, L., Zhang, D., Martin, E., Chen, Z., Li, H., Han, X., Wen, M., Chen, L., Li, Y., Li, J., Chen, B., Ramos, A. K., King, K. M., Michaud, T., & Su, D. (2022). Racial discrimination, mental health, and behavioral health during the COVID-19 pandemic: A national survey in the United States. Journal of General Internal Medicine, 37(10), 2496–2504.
Shim, R. S., & Starks, S. M. (2021). COVID-19, structural racism, and mental health inequities: Policy implications for an emerging syndemic. Psychiatric Services, 72(10), 1193-1198.
Vaismoradi, M., Moe, C. F., Ursin, G., & Ingstad, K. (2022). Looking through racism in the nurse–patient relationship from the lens of culturally congruent care: A scoping review. JAN, 78(9), 2665-2677.