Refuse Patients’ Racist Requests: Rely on Strong Policy, Civil Rights Act, and Legal Standards

​One scenario seen frequently in health organizations that can be difficult to handle well and that can have lasting repercussions for the organization is that of discriminatory requests made by patients on the basis of race, ethnicity, or religious affiliation. Specifically, patients' requests that providers of a different skin color, culture, or religious affiliation not care for them. (Discriminatory requests are not to be confused or combined with requests made for religious or cultural accommodations, which organizations may attempt to accommodate as long as care is not compromised and the Civil Rights Act of 1964 is not violated.)

“The healthcare environment exposes both patients and workers to diversity that they may not encounter in other aspects of their lives," says Jennifer Comerford, MJ, OTR/L, CHC, HEM, Patient Safety Analyst, ECRI Institute, who has treated patients in a variety of settings including inpatient rehabilitation, long-term care, and home care. “This may result in racially motivated requests. Extra attention, care, and a strategy is required to manage associated risks. There should be acknowledgement of requests, yes. But not discrimination."

Whether they are actually increasing in frequency or are simply more visible thanks to the pervasive nature of social media, unfortunate situations involving patients' discriminatory requests have made headlines over the past several years. Recent headlines range from “Racism in Medicine: An 'Open Secret'" to “Providers Must Tread Carefully if Patient Objects to Caregiver." (Howard; “Providers") Whatever the reason, the proper handling of racially motivated requests on the part of patients is becoming a priority issue for more organizations. Healthcare providers share anecdotes of feeling unsupported by their organizations or reacting less than professionally to hate-filled comments.

“People feel emboldened to make such requests," says Deborah Ballantyne, JD, NHA, CPASRM, of ECRI Institute, who worked in long-term care for nearly two decades and as a litigator defending long-term care communities. “It's an ongoing issue."

One experience, shared by a doctor of Indian heritage, describes how the patient berated him at first because the patient's usual brand of insulin was not in the hospital formulary. The doctor attempted to diffuse the situation by proposing an alternate option, and the patient shouted, “Why don't you go back to India!" The doctor lost his composure. “When the patient stopped seeing me as his physician or caregiver, but instead as a foreign face, I was no longer a proud physician at the hospital where I was training. Instead, I was reduced to a passive subject of a xenophobe's abuse. After years of feeling that my race was a nonissue, I was subjected to the same kind of hurtful name-calling that I faced in childhood," he wrote in a 2013 Annals of Internal Medicine editorial. The doctor spoke to his supervisor and “absolved" himself of the patient's care. ...