There’s No Place for Politics at the Bedside

Medicine is largely science, but caring for souls without judgment is an art. This art can be extremely difficult to teach, as well-intentioned diversity, equity, and inclusion programs have taught us over the past several years. Now, in the wake of a divisive election, we have an additional prejudice we all must learn to work through: Politics.

With our country cleaved in half, doctors who voted for president-elect Donald Trump will be treating patients who voted for Kamala Harris, and vice versa. It’s an important moment for healthcare providers and patients to remember that our political inclinations, personal beliefs, and bias are inappropriate in the exam room.

The Influence of Bias

The combination of prejudice and power in healthcare can be deadly. Non-judgmental care is part of the essential contract between doctor and patient. Yet, provider bias, usually unconscious, is part of the fabric of the system. In the past two decades since the revelatory report “Unequal Treatment” was published by the Institute of Medicine, efforts to reverse the harms inflicted by bias upon vulnerable populations have been largely unsuccessful.

The human brain, especially when under the pressure of time and urgency, prefers certainty over curiosity, knowledge over nuance. And so, doctors and other healthcare professionals traffic in “facts” about people based on first impressions from the doorway. Once those judgments are cast, they are murmured in hasty sign-outs, scribbled in chart history, codified, and repeated for years.

When Personal Beliefs Dictate Care

In addition to the highly researched and accepted categories of healthcare disparities, injustices can take other forms as well. Provider behavior can be steered by personal experiences, feelings, and resentments. I once witnessed a nurse harm my friend, a college student who went to her clinic for an abortion. Following the procedure, the nurse removed my friend’s IV with tight and tense movements. As we wheeled out of the clinic to the waiting taxi, the nurse hissed at my friend through clenched teeth, “You little slut.”

When I later learned that the nurse carried a lifetime of despair about her own infertility, I felt no sympathy. As I headed for medical school the following year, I promised myself I would be a different type of clinician.

Despite all my good intentions, I recently found myself on the verge of harming my patient due to my own biased thinking.

I’d been warned by my colleague that Tonya*, an African American patient with Lupus whom I was consulted to see, was “very angry and demanding.” An ugly and well-documented trope — “The Angry Black Woman” — had crept into our sign-out without either of us realizing it. As I walked towards Tonya’s room, I had already made my exit plan if things got too tense. As a consultant on the case, there were others responsible for her health, I reasoned. Luckily, I was working with Chaplain Betty Clark, MDiv, that day.

As we approached the door, Chaplain Clark knocked and asked if we could enter. I trailed behind cautiously. Over the next 10 minutes, I watched Chaplain Clark lean in, not out. She held non-judgmental space for this woman, who began to share her story. It was a rough one. She had been shunted from provider like me to provider like me, each with their foot out the door. Suddenly it was clear: she wasn’t a problem, but my attitude was.

Dismissing people because of our own personal traumas and experience is not uncommon. During my first year of residency, I felt I couldn’t take care of an elderly Nazi with dementia who was admitted to our emergency department. He was harmless, but the large swastika tattoo and his ranting about Jews made me tense and angry. A co-resident agreed to swap patients with me, but I felt somehow derelict in my duties.

Years later, Chaplain Clark, a former sharecropper from Jim Crow Kentucky, told me about the time when she was called to minister to a dying man whom the team had labeled a racist. When she entered the room, she immediately felt uncomfortable. The man and his visitors were talking loudly, laughing, and making no effort to acknowledge her presence. She felt herself to be invisible to them, much like she had felt in white spaces throughout her childhood. Chaplain Clark politely excused herself and left the room. While writing her note at the nurses’ station, the patient’s son came looking for her: “My father appreciated your visit. I hope you’ll come back again soon.”

Sometimes we redeem ourselves, despite our initial misguided thinking. Other times, we remain unredeemed.

Suspending Beliefs

As our country becomes more divided by the day, clinicians will face more opportunities to harm. A stethoscope across one’s shoulder, a chaplaincy collar on one’s neck — these are symbols of power. But it is our job to suspend our own beliefs about or feelings toward a patient and to treat them all as we would want to be treated — with curiosity, compassion, and care.

To be this way 100% of the time is a standard most of us cannot meet. We are human beings after all, with feet of clay. We harbor personal or ancestral traumas, fears, and beliefs that can feel impossible to beat back on a particularly bad day. But we must always strive to do our best, as power unholstered can wreak havoc. And that is not what we signed up for when we took that Hippocratic Oath.

We can and must do better. We must find a non-shaming way to raise awareness of the presence of judgment, bias, anger, and fear in our own minds, and understand the need to tame it. Medical schools to date have been ill-equipped to deal with this taboo topic, ignoring it, or reaching for off-the-shelf courses that too often land flat.

Biased thinking is unlikely to change by calling it out; it can only change through people coming together and setting a new intention. Chaplain Clark and I teamed up years ago to care for patients as a duo. Our collaboration has helped to bring out the best in each of us. Each new class of medical students should work toward this goal too: their education should include processing of their deepest and darkest impulses and behaviors so that they can be aware and motivated to provide compassionate care, even when distrust, prejudice, and bias lurk within them, as they undoubtedly will do.

Hospitals should be safe spaces. But when prejudice intersects with power, terrible harms can ensue. None of us is immune. I urge all healthcare providers to acknowledge and share from our own experiences of holding and transferring bias. In the hospital, we can all be oppressors, and, because healthcare is a service that all of us also consume, we can all be oppressed.

*Patient’s name has been changed for privacy.

Jessica Zitter, MD, MPH, is a critical care and palliative care physician at Highland Hospital in Oakland, California. She is also the founder of Reel Medicine Media, and is currently working on her third film, “The Chaplain and the Doctor,” which documents Zitter’s collaboration with Chaplain Clark and underscores the significance of diversity for healthcare teams and the questioning of one’s own unconscious biases.

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