The immigration ban threatens the health of patients and the public
Benjamin J. Oldfield, MD and Elizabeth A. Samuels, MD MPH
We took an oath in medical school. Earnestly, in short white coats, we acknowledged our “special obligations to all [our] fellow human beings” and our commitment to care for those who sought our help. And now, as full-fledged physicians, we find our ability to fulfill this special obligation obstructed.
The Trump administration’s immigration policies have shaken up families and communities. As the first executive order (EO) barring people from seven majority-Muslim nations from entering the United States. is under scrutiny in the courts, a second, similar ban has also been halted by legal challenges. Outside the courtroom, however, Immigration and Customs Enforcement (ICE) raids are occurring with increasing intensity and breadth.
The impact the EOs would have on our colleagues is clear. Nearly one third of physicians in the United States are immigrants. Hundreds of newly minted doctors from the targeted countries have already filed applications for American residency positions to begin this coming July. Tomorrow on Match Day applicants will learn of their training assignments. Whether these physicians will be able to work at their assigned positions and continue their training remains unknown, creating not only uncertainty for their future, but also a workforce gap in many regions of the US already strained by limited healthcare access.
Beyond their workforce impact, these EOs violate basic human rights by discriminating on the basis of religion and nation of origin, and also abandon our obligations to provide safety and shelter for those fleeing persecution — those seeking our help. In combination with President Trump’s broader immigration platform, the EOs have profound impacts on the health of our patients, our relationships with them, and the broader health of the public.
We both work in the medical safety net: one as an emergency physician, the other as a primary care provider. After the first EO, one of us treated an 18-year-old from Syria. Barely an adult, he’d been in the US for just three months. Anxiety permeated the visit — he was notably different from the warm, talkative person who showed up at the clinic just two months prior. He was reluctant to answer any questions about his family’s move to the US. With the help of a telephone-based Arabic interpreter he stoically offered: “I’m great, everything is fine, and I love this country.”
Perhaps we should we take his words at face value. After all, not everyone feels comfortable sharing intimate life details with a physician. Cultural barriers could have made communication about a complex topic difficult. Maybe he was not ready to talk, or something else was going on that day. However, given the stark contrast from the first visit, it was evident that he was reluctant to share deeper concerns. We worry that the political climate is wedging its way into the patient-clinician relationship — a relationship we thought we’d sanctified in that oath, years ago.
Hospitals and clinics have traditionally been thought of as “safe” spaces: a certain type of sanctuary. Under the Obama administration, which deported more people than any prior presidency, ICE had a policy to avoid such locations. Looming threats of deportation resulted in avoidance of care, even in the face of serious illness. Now, things appear to be worsening. Medical centers that serve large immigrant populations have noticed increases in appointment cancellations, resulting in decreased vaccinations and prenatal care visits. High-profile cases of severely ill patients being removed from hospitals and returned to detention centers are ominous lessons for those debating whether seeking care for potentially serious conditions is worth the risk. It’s a lose-lose situation for both patients and healthcare providers.
Clinicians are now confronting limitations they did not know existed. At a recent town hall meeting at our medical center, hospital leadership and legal counsel recommended that we abstain from writing about our patients’ immigration status in their medical charts. This suggestion gave the physicians in the audience pause. On one hand, failing to acknowledge immigration status was ignoring an important determinant of health and health care access. But on the other, does that outweigh the risks posed by discovery of documentation status and potential deportation? We had mistakenly assumed that patient-provider confidentiality — including what we document in patients’ charts — is legally shielded. We all found the loss of this security deeply unsettling.
It won’t take immigration officials raiding our medical centers or auditing medical charts to cause significant damage. The fear cultivated in this climate is already fundamentally changing the nature of the patient-provider relationship and how we are able to provide care. In support of human rights and our professional dedication to our fellow human beings, healthcare providers must not be silent in the face of discriminatory and hateful policies.
How, then, can we build and protect the sanctuaries of our clinical spaces? We can start simply, by connecting with local organizations that support immigrants and refugees, cultivating medical-legal partnerships, and educating ourselves about how to best maintain the confidentiality of our patients’ immigration status. We cannot hesitate to take these steps nor can we be effective in isolation. Now is the time to engage our colleagues to collectively speak out and make good on what we’ve sworn to do.
Drs. Oldfield and Samuels are physicians in New Haven, CT and postdoctoral fellows in the Yale National Clinician Scholars Program.