Any physician who has spent time taking care of trauma patients has been cursed at, spit at, and more. If you are a woman or member of racial or ethnic minority, some patients have belittled you. If you are from another country and speak with an accent, some patients have requested another doctor.
Almost all the time, most of us just suck it up, finish the job, and move on. It’s the ER. We’re there to do our job, not make a new friend.
One provocative post asked the question, When treating neo-Nazis, should physicians have a choice? The doctor, Alberto Hazan, prepared to suture a deep stellate laceration on the underside of his patient’s biceps. Adjacent to the wound – a swastika tattoo.
“Sir, we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain medication. The nurse will update your tetanus shot. But before I start, I need to point out that I find your tattoo offensive.”
“You’re a doctor,” the patient said. “You’re not supposed to tell me that.”
“Sir, you have obviously chosen to exercise your freedom of speech by getting that swastika tattoo on your arm. I’m simply exercising my own freedom of speech by letting you know that I’m disgusted by your tattoo.”
The patient jumped up and left the emergency room.
Dr. Hazan posed the question whether he was wrong to voice his opinion.
“My recent experience with the neo-Nazi highlights the importance of keeping personal beliefs out of the realm of medicine. Physicians should rise above this ignorance. We should be held to a different standard because people’s lives are literally in our hands. While we are in the hospital, we shouldn’t express any of our political or personal beliefs, not to each other, and certainly not to our patients.
That’s what blogs are for.”
This is sometimes easier said than done.
I spoke with a surgeon earlier this year who faced a similar situation. The patient was being seen for an elective condition. The patient had a swastika tattoo on his leg; and he was wearing shorts. The surgeon said the tattoo was offensive and told him he might have a difficult time treating him. The patient said the swastika was a foolish decision made years ago, and he did not have the funds to have it removed. Nonetheless, the patient made no effort to cover it with a bandage or even pants.
Many years ago, I took care of a belligerent drunk. He had fractured his lower thoracic spine, but was neurologically intact. Once the patient was turned over on the operating room table, right in the middle of the planned surgical incision, was a swastika tattoo. The surgery went as planned. I made a reasonable effort to bring the skin edges together, but, perhaps not with the skill of a plastic surgeon.
I resisted the urge to implement the scrub tech’s suggestion; bring in a plastic surgeon and rotate a couple of flaps to convert the tattoo into a Star of David.
Some patients send vibes that makes it harder to care for them. Some may be murderers, some rapists, some pedophiles. I readily concede that putting aside one’s personal feelings and just taking care of the patient is less challenging for some physicians. And, it’s probably not as difficult when dealing with acute, once-off treatment, compared to treatment requiring prolonged interaction.
What do you think?
I was a surgical resident at a VA and Army hospital during the Viet Nam war. We all remember how divisive that war was. That divisiveness extended into the VA hospital. One of our senior anesthesiologists was very much against that war and was not silent about his opposition.
That might have been expected, given the fact that he saw the damage it caused young men during that conflict. But it went much further with him. He told anyone who would listen (I had no choice; I was just a resident) how much he “hated the United States” and felt it was the worst possible place to live.
He believed this country to be not just culpable for the Viet Nam war but also criminally liable. He would openly rant in the change room where we would change into our greens. In the hallways he would openly curse President Nixon and swear publicly, not caring about his language choices.
Everyone could easily hear him, from patients to all staff members. He frequently used the “F” word as well. He was always very nice and polite to me personally, as well as my patients and he served as my anesthetist often and competently. He was generally ostracized by the staff. Once, during a holiday Yvonne and I had him over for dinner, because we felt sorry for him and we had no family available to invite. We were far away from home.
He ranted and raved all through dinner. I tried to change the subject because it was getting to Yvonne, who obviously didn’t feel the way he did. There was nothing I could do about him but I was sorely tempted to ask him why he stayed working for the VA. But residents must always be cautious.
To my knowledge he was never reprimanded and he was certainly not fired during the time I was a resident. He certainly “used” his freedom of speech and was never punished for it by our Government or the VA. They certainly could have “released” him for swearing publicly. But they never did. Maybe they feared a lawsuit. I don’t know. But he seemed to be treated with kid gloves. That was many years ago. I don’t think he would be tolerated now.
Michael M. Rosenblatt, DPM
In my opinion, the best course of action in this kind of situation is to just do your job to the best of one’s ability and not be judgemental. We are there to treat our patients, not judge them.
If one sees a sign on someone’s T shirt or a tattoo offensive to one, the best course of action is to ignore it completely. Confronting someone in this context runs the risk for making the other party a free speech martyr.
I will mention two experiences I had in this regard.
In 2007 I was a senior resident working in the ICU. I had just come back from a large antiwar rally in Washington DC where I saw some famous Hollywood celebrities. While working in the ICU I had a few minutes of downtime and I chatted with one of the ICU nurses, who was a former Air Force nurse about my excursion. I told him the names of the famous celebrities like Susan Sarandon,, Maxine Waters, Tim Robbins, Sean Penn and Jane Fonda I saw at the rally. He did not seem enthralled by my selection of famous people, so when I went on about their names, one of the other nurses turned around abruptly and started saying things like – do not say anything against my country – “you are a guest in our country, you have no right to say things like that – this country means so much to me”……I tried to placate her and calm down the situation to no avail.
A junior resident who was some distance away overheard the conversation and later alleged in her evaluation of me that I had argued with the nurses over a political subject and had been “unprofessional”. Well no, not quite, I only mentioned the names of Hollywood celebrities I mentioned in an anti war rally, which should not be offensive simply because they happen to be on the left of the spectrum.
I do not believe I did anything wrong, even several years later.
The second is when I saw a lady with a badge on her sweater crossing off the work ISLAM on her jacket at a medical conference. While the badge did indeed make me uncomfortable, I ignored her completely.
Doctors have a responsibility to be professional in a workplace, irrespective of whether their co workers or patients are the same way.
As the son of a holocaust survivor I could think of nothing more repugnant than seeing a swastika tattooed on a patient. When I was in general surgery residency rotating through ortho as an intern I remember assuming care of a patient who had been on the service for some time. He had swastikas and other Aryan tattoos on his body and I told my senior resident that I was not comfortable treating him. My resident told me that the patient was actually a very nice guy and that I shouldn’t judge him because of his tattoos. The reason he had them was that he had been in prison at an earlier point in his life and in order to survive he had no choice but to associate with the other white prisoners or risk getting shanked or raped by a black or latino inmate. As I took care of him I learned that he really was a nice guy and was very embarrassed about that part of his life. He wanted to get rid of the tattoos but did not have the means to do so. Just goes to show that you really can’t “judge a book by it’s cover”.
Recently took care of ex sheriff who came in wearing multiple rings with swastikas on them. He turned them inside and hid them in his fists. He first refused to let me exam his hands. When I insisted and saw the rings, he claimed to be a military buff. I told him I preferred he not hide the rings that I prefer to now what he was wearing and had to exam him, no matter what. I treated him professionally just like any other pt. Felt maybe he would learn something and feel guilty about wearing them. He wore them on followup. At least this time I wasn’t taken off guard.
Rather than asse the worst, and allow our own emotional reactivity shape our interactions with patients about whom we know virtually nothing, it might be a more compassionate choice to assume nothing, and find out more about the person sporting the ink. It might not mean what we’ve all been programmed to think it means…
http://altreligion.about.com/od/symbols/a/Swastika.htm
I meant to type “assume”
The Swastika in its essence is an ancient Indian symbol which symbolizes happiness, prosperity and wealth.
The word Swaasth in Sanskrit means health and that is where the word Swastika is derived from. The German misuse of the symbol is a far more recent phenomenon.
People should distinguish between the use of the symbol by neo Nazis and Hindus. Neo Nazis use the symbol to show hatred and support an ideology which led to the deaths of millions. On the other hand, the use of the symbol by Hindus is an ancient rite which should not be confused with neo Nazism.
Save a life. Pray you get through the case unscathed, and perform inverted closure with clips.
The comments already sent imply a duty to treat and that the writer felt better about themselves by demonstrating mercy, compassion and suspended judgement. Even the swastika symbol itself has been defended.
The Nazis of 1939 and Neo-Nazis of today relied and rely on this charitable and greater spirit to allow time for their poisonous seeds to grow and spread. The tolerant allow the intolerant to spread the word of intolerance.
I completely disagree with this philosophy in this context and throughout life and politics. Hate and hate speech must be revealed, confronted, embarrassed, and rebuffed – not tolerated.
A patient has rights and they should be respected. Within those boundaries, holding one’s tongue in a non-emergent setting while dealing with a person whose belief system is to not tolerate yours is inherently suicidal and abandons your duty to the rest of your community and the world.