Physician assistant Candice Fori has three strikes against her, in the minds of some of her patients. She’s not a doctor. She’s a woman. And she’s African-American.  

When patients ask to be treated by somebody else, she deflects the tension with conversation. “I ask why, and usually they come around,” says Fori, whose gynecologic oncology clinic is in The Johns Hopkins Hospital. “Sometimes if you step back and talk to them a little bit, you build trust. I’ve never had anyone get really aggressive.”

Still, the slights hurt, she says. “It weighs on you.” 

Fori spoke during the question-and-answer period of a talk called “Dealing with Racist Patients,” sponsored by the Berman Institute of Bioethics as part of its twice-monthly lunchtime seminar series.

The speaker was Kimani Paul-Emile, associate professor of law, associate director and head of domestic programs and initiatives at Fordham University School of Law’s Center on Race, Law and Justice, and faculty co-director of the Fordham Law School Stein Center for Law and Ethics.

Paul-Emile’s recent scholarship seeks to untangle the conflicts that arise when patients reject clinicians because of their race. About 75 people attended the talk in the Chevy Chase Bank Conference Center. By a show of hands, it appeared that about half had experienced discrimination from patients.

“This is a critical ethics issue faced by many health care providers,” says Jeffrey Kahn, director of the Berman Institute. “How should they carry out their duty to care for patients when faced with behavior at odds with their and their profession’s core values of equality and nondiscrimination?”

Paul-Emile said her initial reaction “was that this type of behavior shouldn’t happen, and if it does, it certainly should not be accommodated.”

As she delved into the issue, her research findings helped to change her mind. Now, she believes clinicians should sometimes comply with race-based patient requests. 

The classic portrait of a racist patient is a white man demanding a white male doctor, she said. But what about an African-American man demanding an African-American male doctor? Or a Muslim woman who prefers a female doctor?

Race-based requests are sometimes rooted in legitimate concerns, said Paul-Emile. They could be cultural, like the Muslim woman’s request, or a logical reaction to a history of discriminatory treatment in the healthcare system, like the African-American patient’s. Some patients may be looking for a physician who they feel understands their experiences and will show them respect.

In those cases, she said, assigning a different provider can build trust, which improves care. 

One consideration is that hospitals must provide discrimination-free workplaces for their employees and therefore can’t assign clinicians to patients based on race. However, it may be appropriate for clinicians to decide whether to comply with race-based patient requests after weighing clinical and ethical considerations, said Paul-Emile. 

Her caveats: The physician must be comfortable with the decision, employment rights must be respected, and the action must not compromise the delivery of quality medical care.   

No matter the reason, clinicians can often change a patient’s mind through conversation, Paul-Emile said. That’s what Fori has learned. “I usually use humor and try to get their trust,” she says.  

Have you had an experience with a racist patient? How did you handle it? Tell your story in the comments section below – protecting patient privacy, of course.