When I took the Hippocratic oath in 2007 as a new medical student, I made a solemn vow to uphold the highest values of medical ethics. We learned in medical school that the four pillars of medical ethics are beneficence, nonmaleficence, respect for patient autonomy, and justice. Beneficence is the promise to do good or provide a benefit for others. Nonmaleficence is the obligation to not intentionally inflict harm on others, often expressed in the phrase, “first, do no harm.” Respect for patient autonomy is acknowledging the fact that people have a right to make choices, hold beliefs, and take action based on their values. Justice is the commitment to treat others equitably and to distribute benefits and burdens fairly. When I graduated from medical school and became an intern, I was ready to do good while treating my patients fairly, and to the best of my abilities.
But what should a young doctor do when they meet a patient that has no interest in treating you with the same values? What if the patient has already judged you based on your appearance and the color of your skin? By doing so, what if they have taken away a small amount of your light and passion to help others? Today, I am recounting my first encounter with racism as a new doctor and how it has affected me.
When I was an intern, an intern on the internal medicine service cared for about 10 patients each day. It was common for the service to have 2 interns for a total of 20 patients under the care of one supervising attending physician. The interns would show up bright and early in the morning and pick up new patients that had been admitted to the service overnight by the evening team. The early morning hours were the busiest because we had to assess the patients we already had from the previous day, pick up new patients and be ready to present our assessment and plan for each patient to the attending physician during morning rounds that started at 8 AM. A good intern would even have most or all of their documentation completed before morning rounds. I was determined to be a good intern in those days.
One morning, I picked up a new patient that was admitted overnight in addition to the 9 patients from the previous day. My custom at the time was to start my morning by assessing the new patients first. I walked swiftly down the halls of the medical ward. My footsteps were slightly rushed but calculated. I arrived outside this new patient’s room, well-caffeinated, and ready to conquer the morning. I looked at my watch. I had plenty of time. Let’s do this.
I gently knocked on the door and entered his room.
“Good morning, sir. My name is Dr…”
Before I was able to complete my sentence, he interrupted.
“Nope, nope, no sir. You can’t be serious. Look, I’m really sorry and no offense, but I really don’t want an oriental as my doctor. I can’t believe how much things have changed in this country. I guess they let anyone become doctors now.”
I looked at him with confusion, still trying to process what I had just heard.
“Look, buddy. Is there any way I can request to have a white doctor? I will pay extra if I have to. I’m sure you are a nice guy but I just do not want to have an oriental as my doctor. Too many of my friends died in Vietnam because of you chinks. What does someone have to do around here to get a real doctor?”
I stood there for a second, paralyzed in disbelief by the words that had been spoken.
My mind just went blank. Everything I learned in medical school about how to talk to difficult patients flew right out the window. Needless to say that the mood in the room had become awkward and uncomfortable because of my prolonged silence.
He stared into my eyes for a few seconds and sunk his forehead in between his hands with a sigh. I’m sure he saw the shock on my face. I was an inexperienced new doctor. I did not know yet how to control my emotions or prevent my face from showing them.
I felt my heart racing. I felt hot and uncomfortable. I tried to think of something to say.
Say something. Say something to let him know that what he said was inappropriate and will not be tolerated here. Say something to make him understand that the color of a doctor’s skin has nothing to do with their knowledge or clinical judgment. Say something to inform him that the term ‘oriental’ is used to describe objects like a rug and not people. Say something and let him know that you weren’t even born during the Vietnam War.
All kinds of thoughts were racing through my head, but I was unable to speak. It was almost like my breath had been taken away from me. My lips felt like they each weighed a thousand pounds.
Say anything and break this silence, man.
After a few seconds that felt like an eternity passed, this is all I came up with to say to him:
“I am sorry, sir. I will find out what my team can do to better help you. Have a nice day, sir.”
I walked out of his room and closed the door behind me. I walked into the physicians’ workroom and sat down on a chair. By this time, my emotions were running rampant. I started to realize what I was feeling.
I felt anger. I felt shame. I hated myself for not being able to think of something better to say to defend myself. I hated myself for apologizing to a man who had just made it clear that he thought that I was sub-human. He was suggesting that I was unable and unfit to fulfill the duties of a doctor, because of the color of my skin. In saying so, he had insulted my parents, my entire family, and my heritage. I already knew at that time that I had a lot of things to learn to become an experienced and competent physician. I felt that he implied that I would never become one. To him, there was no need to evaluate my aptitude, work ethic, or commitment to do good for others. To him, no matter what I did, I would not be good enough to be a real doctor because of the way that I was born. He would have rather suffered through his illness than to have accepted the help of an Asian doctor.
It was not a joke. He fully meant every word. His disdain for people that looked like me was raw and out in the open for me to feel.
I looked at my watch. Too much time had gone by. I still had to see 9 other patients before rounds. I picked up the phone and called my upper-level resident who was white. I told him what had happened. My upper-level was very supportive and said that he would go see the patient instead. I thanked him and jumped out of my seat to continue the work that needed to be done.
Just like thousands of doctors across America that experience similar moral injuries every day, I continued working. I continued to care for those in need and put my feelings aside. My footsteps had a little less energy and a little less purpose for the rest of that morning. I did not tell my attending physician about what happened. We already had enough work to do. I did not want to burden the team with my personal conflict with this patient. I did not want to talk about it.
During rounds, I had to face the patient for a second time. I listened to my upper-level resident’s assessment and plan of the patient inside his room with the rest of the medical team. The patient talked to the attending physician and asked him questions about his medical care. The patient and I did not make eye-contact during rounds. I kept my thoughts and feelings to myself that day. I tried to stuff it down and told myself that this is a part of what it takes to be a physician in America. I told myself that I was one step closer to becoming an experienced physician.
I wish that I could say that this was my only encounter with racism as a physician. It was not. I have had an African American lady call me “Hey, Chinatown” in the hospital. I have had a pregnant woman tell me that she would only let a Jewish doctor place her epidural catheter. She demanded that I call in a partner of mine from home at 2:30 in the morning. I have had a young white boy shout, “Don’t touch me, you Chinese” while I was trying to remove an epidural catheter in front of his parents. I’m not even ethnically Chinese. I’ve had a teenager whisper “ching, chang, chong” while passing me by in the halls. I’ve even heard someone say, “I cannot believe that they are letting all of these foreigners take all of our jobs away” while I was in line at the cafeteria of a hospital, in my white coat. Each time, I was too busy to take the time and effort to make a big scene and address it directly with those individuals. Each time, the level of shock that I felt was a little less. Each time, my reaction has become a little less emotional and more controlled. I do admit that each of these experiences has taken away small pieces of my trust and passion for people. Now I am much more aware when I am in a place where my family is the only Asian family present. I now know for certain that there are real people out there who judge me by the color of my skin.
Now, 9 years after my first encounter with racism as a doctor, I finally think that I know what I would like to say to that man if I got a chance to meet him again. I am glad that I did not say anything to him out of anger and frustration back then. I am proud to say that I did become a board-certified, consultant anesthesiologist. I am thankful to have had the pleasure and privilege to help many people in need. I am blessed to know that the vast majority of my patients are respectful, fair, and loving people. They remind me daily why I chose to enter into this profession. The few people who have expressed their racism and prejudice towards me will not define the way that I perceive their entire race or culture because that would just be silly. I will choose to see the beauty of the doctor-patient relationship in the thousands of good people I have cared for rather than to focus on the disappointment I experienced from the occasional prejudiced person. My silence so far towards the racism I have experienced as a doctor does not equal complacency. I have simply tried to let my actions speak louder than my words. Today, I am adding the power of my words to help uproot racism in all shapes and forms.
Most of all, I am glad that after 9 years, I have finally given myself a chance to process my thoughts and feelings to give him the following response:
“My commitment as a doctor to my patients is to treat everyone just like I would treat my own family. If your child is injured, I will be gentle, silly, and caring like I am to my own daughter. I want to ease her fears and let her know that the world is full of great people who want the best for children. If your mother will need a hip replacement, I will look after her like I would my wonderful but fragile mother. She is my world and I understand that your mother is the person who has always believed in you. If your father will need an aneurysm repair, I will obsess over the details to make sure that everything goes perfectly, as I would want for my father. He is the backbone and foundation for my life and I have never known this world without him in it. I want to keep it that way. If your spouse is bleeding to death from an accident, I will drop whatever it is that I am doing to be there to stop it. I will run, I will work tirelessly, and do everything that I know how to do to protect her. I will pray that God will use me to help spare her life. That is what I will do to save my true love and my best friend. I am ready to do that for your spouse. I will share a laugh with you when all goes well and we will celebrate your improvement and in some cases, cure. When a life is tragically lost in the operating room, I will grieve with you. I cannot change your loss, your pain, or overwhelming sorrow. But if you will let me, I don’t care what you look like and where you are from. I will be there with you as a person. I will be there as your doctor.”