Quentin R. Youmans, MD
Acknowledgment: I thank my program director, Aashish K. Didwania, MD, for his unconditional support; unqualified validation; and equal contribution to this manuscript.
Corresponding Author: Quentin R. Youmans, MD, 676 North Saint Clair Street, Arkes Pavilion, Suite 2300, Chicago, IL 60611; e-mail, email@example.com.
Audio. Virginia Hood, MD, reads “The N-Word” by Quentin R. Youmans, MD
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Ellen Tattelman MD, Tanya White-Davis PsyD, Mary Duggan MD
Montefiore Medical Center/Albert Einstein College of Medicine
September 30, 2019
We would like to thank Dr. Quentin R Youmans for courageously sharing his painful story and insightful analysis. Since residents, faculty, and staff in the Residency Program in Social Medicine at Montefiore Medical Center in the Bronx, NY have reported equally painful experiences dealing with patients’ racist behaviors, we have developed, with resident and faculty input, a standardized protocol. We used the New England Journal of Medicine 2016 article “Dealing with Racist Patients” by K. Paul-Emile K., A. Smith A., B. Lo B., and A. Fernandez as a starting point. Our protocol ensures that the team caring for the patient processes the incident in order to support team members, emphasizes their unified position of intolerance of racist behavior and plans an intervention. This seems similar to the plan that Dr. Aashish K. Didwania, Dr. Youmans’ program director, has developed. It is critically important for medical centers and residency programs to create safe, supportive and respectful work environments for all members of the care team. Responding to racist patient behavior appropriately is challenging and requires adequate training and preparation for faculty, residents and staff. Teams need to practice explicit strategies and dialogues for professionally challenging and disrupting racist patient behaviors. We have begun ongoing trainings for residents and faculty at the residency program and trainings for the teams in the inpatient and outpatient settings in which we work. We are currently working to develop a system to document and monitor racist patient interactions, responses and outcomes institution-wide. We will happily share our protocol with anyone who is interested.Paul-Emile K., Smith A., Lo B., Fernandez A. Dealing with Racist Patients. N Engl J Med. 2016; 374:708-711.Olayiwola JN. Racism in Medicine: Shifting the Power. Ann Fam Med. 2016;14: 267–269.Jain SH. The racist patient. Ann Intern Med 2013;158:632-632.Whitgob EE, Blankenburg RL, Bogetz AL. The Discriminatory Patient and Family: Strategies to Address Discrimination Towards Trainees. Acad Med. 2016;91:S64-S69.Crutcher R., Szafran O., Woloschuk W., Chatur F., Hansen, C. Family medicine graduates' perceptions of intimidation, harassment, and discrimination during residency training. BMC Medical Education. 2011;11:88.
Quentin R Youmans, MD
October 4, 2019
I thank Drs. Tattelman, White-Davis and Duggan for their thoughtful input in response to my On Being a Doctor piece, “The N Word.” While a painful story, I am heartened by its potential to be a call to action for academic centers. Indeed, these experiences occur with an unfortunate frequency and require a standardized approach that ensures a timely, uniform, and unambiguous response. The system of training being developed at Montefiore Medical Center is to be emulated as it gives all members of the medical team the tools to approach these often-delicate scenarios. I would additionally direct readers toward work done recently by Drs. Williams and Rohrbaugh published in Academic Medicine in which they outline how the affected resident, unit, and institutions might respond following these experiences.1 I hope that this piece continues to serve as a clarion call to encourage further sharing of ideas about how we may best support all of our colleagues.
1. Williams JC, Rohrbaugh RM. Confronting Racial Violence: Resident, Unit, and Institutional Responses. Acad Med. 2019;94(8):1084-1088. doi:10.1097/ACM.0000000000002610
Youmans QR. The N-Word. Ann Intern Med. 2019;171:380–381. doi: https://doi.org/10.7326/M19-1269
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Published: Ann Intern Med. 2019;171(5):380-381.
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