Everyone' s a little bit ...?

As part of my student membership in the AMA (because I like to maintain some semblance of political understanding), I get a free four-year subscription to JAMA. I don't often read it, because I have enough to read, and I can never really understand all the drug trials and whatnot anyway. All that doctor-y stuff seems so far away.

But today, as I was idly flipping through it on Google Reader, I came across this article, which echoes many of the sentiments I've felt in the past. As the American-born child of Indian immigrants, I've had to deal with back-handed "compliments" like "Wherever did you learn to speak English so well?" "Um... Northern Virginia." (I was tempted to add "What about you?", but as it was my supervisor at a summer job, I thought it unwise.) The worst that's happened to me, I think, was profiling by the police at Times Square on New Year's Eve.

Usually, it's older people who say things like this, but I'm not sure that's such a great excuse. After all, by "older" I mean people in their 40s and 50s, the generation that grew up during the civil rights marches. And sometimes, even from my peers. (One of my classmates once said, laughingly, that she was the only American in our group of 2 Canadians, 1 Chinese girl, 1 Colombian, her, and me. "Hey," I responded with a smile, "I'm just as American as you!") There was even a time -- and I'm ashamed to admit this now -- that the frequency of these comments made me wish to be Caucasian, just so that people would accept me as the nationality I am.

There is a lot of talk about the melting pot (I believe the new PC metaphor is the "salad bowl") but when it comes down to it, this country -- or certain segments of it -- unfortunately say or do things that are xenophobic. Not even xenophobic, because as I say, I'm not foreign-born, and immigrants of European ancestry, as the article points out, usually never encounter these problems. Come on, come on, let's use the word: racist.

The author of the article is, I think, a little overgenerous in her dismissal of the racist comments she's encountered. A diagnosis of a serious illness is certainly overwhelming, but it doesn't give you a free pass to be an ass. She also argues that her own "profiling" of physician-colleagues encourages patient discrimination, but again, that doesn't excuse the patient at all. Each of us is responsible for our own actions and thoughts.

Which begs the question: how to deal with patients who make openly racist or discriminatory comments? I'm sure I'll encounter some. Is there any sort of recourse for physicians who are discriminated against by the people we are supposed to be helping? Does professionalism really demand that one ignore these issues? At what point will I be confident enough in myself to say -- both in my professional and my personal life, "Excuse me, I find your comments to be unacceptable."

[Edit: I think I should point out that I wouldn't withhold care as "revenge," though I suppose I would ask that another physician take over the case. But really, that's just running away from the issue.]

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