Amidst the mid-morning rush at clinic, I’m saying goodbye to a patient whose visit just concluded. In the corner of my eye, I see a woman sitting in the area where patients wait after they have gotten their vitals. She is shifting continuously in her seat. Suddenly, the woman springs up out of her chair and walks toward the nurses’ station. The patient I am speaking with remarks, “Oh! Wonder what’s up with her?”
It turns out the shifty woman is one of our patients. The resident I am working with that day (we’ll name him Steve) calls her to come into the exam room. The woman stays seated and is staring down at her phone. After saying her name a few more times (slightly louder each time), the woman finally gets up and comes into the exam room. Her gaze remains fixed on her phone. After establishing that she needs a health maintenance form filled out for work, Steve begins to ask her a few questions. Upon seeing that the woman still won’t make eye contact, Steve requests that the woman put her phone away.
She replies, “I can hear you just fine,” and continues to scroll aimlessly on her phone. I know Steve. He is animated, opinionated, walks way too fast, and never fails to speak his mind. He also has very specific pet peeves, one of which is patients not paying attention to him while he is trying to speak to them. Needless to say at this point, I could see the back of his neck quivering. He once again asked the woman to put away her phone, so they could discuss items that needed to be updated in her chart. She exclaimed, “Excuse me?!” once again refusing the request and kept giving curt one-word replies to any questions we asked.
It was now time for me to do her physical. She finally made eye contact and cooperated during the exam. As I was doing her HEENT exam, Steve asked in a gentler tone “Are you doing ok? Is everything alright?” She looked down and mumbled, “I’m just sleepy.” After this, we sent her to wait outside for the nurse so she could get an immunization. It was a baffling encounter.
Steve left the room while I was looking up information about our next patient. He came back after some time and told me the patient spoke to the nurse while getting her immunization. The reason her affect was so distant was that she was infuriated at being seen by a gay doctor.
I was shocked. Yes, Steve is gay. And yes, I suppose if you were meeting him for the first time you might mentally make that assumption without him telling you. But this was the first time I had seen a patient be so rude to a person who was responsible for taking care of not only her health but that of so many of his other patients. This fact saddened me, but I was also disheartened by the way Steve told me the news and then continued with his busy day seemingly unaffected.
It made me think, “I guess this isn’t the first time something like this has happened.” Steve did what he had to do, and I realized that if we are the only ones available to help at the time, no matter how unpleasant, racist, misogynistic, or homophobic a patient is, as health care providers we can never turn our backs to the principles of nonmaleficence and beneficence.
Pragya Kalla is a medical student.
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