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?