Undermining the Caregiver

‘Aren’t there any white doctors here?’ a clinic patient asked me once. ‘No’, I said. We had three doctors from Ghana and one from Egypt.

Like many primary care clinics, this one was staffed by young doctors starting their careers, some fulfilling a committment to the US Health Service, and they tended to move on after two years. The demographic mix was always changing. If I were looking for care for myself I would have chosen the doctor I thought best for my particular complaint. That could be any one of them depending on what illness I had.

Choosing a doctor by race or ethnicity is no better than choosing a doctor by astrological sign. And yet, there is enough prejudice remaining in our society to cloud patient’s judgment when they choose a doctor. Here is one doctor’s account of his education in medicine from his surgery professor, and in racial politics from his fellow students…

“If I were sick,” I said to my fellow resident that night, “I know which surgeon I would ask for.”

“But you can understand why some patients and referring doctors don’t go to him,” she replied matter-of-factly. “Other guys wear Brooks Brothers, have recognizable last names and carry a degree from the ‘right’ medical school. But when a potential patient or referring doctor sees our guy, all they might notice is a foreigner with an accent and a strange name who graduated from a medical school in some developing country.”

The prestige of having an MD doesn’t protect doctors from various kinds of disrespect, including prejudice. How much more exposed is a hands-on health care provider who does the hardest work for low wages.

INDIANAPOLIS (AP) — Certified nursing assistant Brenda Chaney was on duty in an Indiana nursing home one day when she discovered a patient lying on the floor, unable to stand. But Chaney couldn’t help the woman up. She had to search for a white aide because the woman had left instructions that she did not want any black caregivers. And the nursing home insisted it was legally bound to honor the request.

Excluding a couple of nursing homes in the far corners of the state, the majority of nurses aides on teams I have worked with are women of color, and/or immigrants. Most often the relationship between caregivers and patients is a benevolent one. It has to be, there’s no energy to spare for conflict. Sometimes an assignment ‘doesn’t click’ and the patient is re-assigned. This is common and no big deal. I have never worked anywhere that made discrimination a matter of policy. This is just so wrongheaded.

It’s true that patients have rights to feel comfortable, the law recognizes that…

Courts have held that patients can refuse to be treated by a caregiver of the opposite sex, citing privacy issues. But the 7th U.S. Circuit Court of Appeals, ruling in Chaney’s case last month, said applying that accommodation to race goes too far.
”The privacy interest that is offended when one undresses in front of a doctor or nurse of the opposite sex does not apply to race,” the ruling said.

Caregivers are workers providing a skilled service. Patients are diverse and have different needs. Caregivers have to work together as a team or the job becomes much more stressful and patient care suffers. Undermining the caregivers and dividing them by race can only hurt morale and send a message that some workers are less valued than others.

I’m so glad that the organizations I worked for never interpreted patient’s rights as erasing the non-discrimination policy required by federal law. I can’t imagine what Brenda Cheney felt each working day…

Documents in Chaney’s lawsuit, filed in 2008, say her daily assignment sheet at Plainfield Healthcare Center always included the reminder that one patient in her unit ”Prefers No Black CNAs.”

It’s a bad road to go down, accomodating prejudice. The range and variety of prejudices I have encountered in eldercare would make it impossible to function if an organization tried to indulge them all. Much better to have a clear policy of non-discrimination and focus on getting the job done. It’s a tough job, and those who do it deserve respect.

ALL AMERICAN: It’s worth noting, also, that Brenda Chaney is African-American. There should have been no cultural barriers or communication problems. Her family has been American for centuries. This instance of discrimination was based solely on skin color. It’s a painful reminder that the color line has not been completely erased.

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3 responses

  1. You always seem to manage to find these kinds of people.
    I’ve been treated by all kinds of caregivers and I can’t see any difference between them baed on race or ethnicity.They’re good or not,period.
    I think this is mostly older people who are holdovers from a time when almost all medical professionals were either White or otherwise practicing in their”own”communities.
    It’s hard to imagine anyone under 80 acting that ignorant.
    Fact is,particularly where doctors are concerned,we often get the best practitioners from all over the world.
    Good medical schools like Brown don’t attract nor accept second rate people in their residency program.

    1. I agree….good or not!

      I recall my grandmother was in a nursing home and the home health aids were Hatian and she used to say horrible things. She was a racist to those that knew her and I was never my grandmother’s child…I was color blind, but ethics driven.

      I want the most qualified person to advise, service and protect me PERIOD!

  2. Same here. I see it a little more from the inside, and you want someone with good skills and compassion.
    The NYT article this is based on was published yesterday, Yahoo News headlines it today.
    Nurse’s aide Brenda Chaney won a lawsuit because the nursing home she worked for had discrimination written into policy on the mistaken idea that patient choice includes the choice to say ‘I want one of those’ when accepting care from a worker.
    It would be chaos in my job if we tried to accomodate patient’s preferences in religion, foreign language skills, race, age, politics or whatever. It would never end.

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