Renuka Gupta, MD
Requests for Single Reprints: Renuka Gupta, MD, New York-Presbyterian Hospital, 525 East 68th Street, Box 130, New York, NY 10065.
Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Slaves," by R. Gupta.
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Norman Jensen, MD, FACP
University of Wisconsin
November 4, 2016
I feel sad and sorry you had to endure this bigoted bullying. Your silent pain and humiliation is what I expect most of us would feel in response to such aggressive racism. It would be challenging to not accept some part of this aggression as reflection on oneself as person and doctor. Your courage in sharing the story helps all of us to feel less alone with such tragic events. And then, your curiosity about alternative responses to patient aggression prompts my offer of this one as a gift in first person narrative: If I am secure (most of the time) in my professional motivation and competency, I am allowed to take refuge in that secure place when I am verbally attacked. When my attacker has no basis in prior experience with me or my reputation, I can conclude the attack is not rational, that it comes not from a legitimate place of power, but likely from a place of prejudice, weakness, vulnerability and activated emotional state.When I’m at my professional best, I might even imagine my attacker would be less offensive, perhaps even a bit likeable when clothed and well. However, that’s a lot to expect when under attack, and, of course, not even recommended when my physical safety is at stake.In response to verbal attack, I have learned to take refuge in my sense of competency and altruistic motivation; I refuse to internalize the attack trusting it’s irrational, not about me. When I succeed at this, I can avoid being disempowered and deskilled; I can better stay in helping relationship, imagining the attack arises not only from prejudice, but from fear of illness, disability, death, and abandonment by primary doctor. I can imagine also my attacker has never before experienced unbiased compassionate strong medical care from a doctor like me. And when I can stay strong in my helping role, I can use my communication skills aiming to transform a disruptive attack from unmanageable presence (like an elephant in the room) into a relational event, something talk-about-able via empathy, curious open-ended inquiry, reflective listening, shared decision making and repetitive assurance of my commitment to my attacker’s best possible health in partnership with primary doctor.Macro-aggressions like you endured are hopefully less common than micro-aggressions, the every-day prejudicial insults like referring to a woman doctor as “nurse”, depreciating a young doctor’s youth, or passive-aggressive disrespect for a doctor of color or accented English. I assume until proven otherwise the prejudice comes not from negative experience but from lack of positive experience. My response of first choice then is to stay in empathic respectful helping relationship as much as possible. More often than not, I’ll wager, that wins the day.With my warmest collegial support and best wishes,Norman Jensen MD MS FACPFellow, American Academy on Communication in HealthcareProfessor Emeritus, University of Wisconsin Department of Medicine2828 Marshall Ct, #100Madison, WI, 53705
Mission Hospital, Asheville NC
November 5, 2016
Patient rights versus human dignity
I am deeply saddened reading this article. I am proud of the author for speaking and writing about this. But I wish I could have been there to say a few words to that bigoted, abusive man. I will cut people a lot of latitude for being sick and in pain, but there is a line I think still exists even if you are a patient. In what other professional setting is it OK to treat someone this way?
Yesterday, a nurse paused outside a patients' room as we were about to go in to round together. She said, "I'm not going to cry, but I am tired of being treated this way." She went on to describe the patient belittling her, cursing at her, questioning her abilities, and making unreasonable demands. She went on to say, "I know we are supposed to try hard to get good satisfaction scores, but it is hard to keep trying to please someone who is so mean." We went in the room. The patient made a few angry comments, then accused the nurse of not doing her job and not knowing what she was doing. I said, "Please do not say that to the nurse. She is a good nurse, and I expect you to treat her with respect." Are we not allowed to say this?
Adil Alharthi, MD
Consultant internist at KFAFH Jeddah KSA
July 16, 2017
I'm sorry I read this Article too late, but it moved me too much. I need to say that I could never pretend to understand the Authors feelings being a male and practicing at my native land.but never less, I must say if I faced a similar situation I couldn't have the courage to deal with it the same way Dr. Gupta did. I want to thank her, not only for her courageous response and her ability to share this incident with others, but also for teaching me how to respond in a way that reflects ones professional manners rather than adapt this patients low manners for revenge.
Gupta R. Slaves. Ann Intern Med. 2016;165:671–672. doi: https://doi.org/10.7326/M15-2370
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Published: Ann Intern Med. 2016;165(9):671-672.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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