When Prejudice Influences Patient Care

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A clinician reflects on a time, early in her career, where prejudice played a role in her treatment of a patient.
A clinician reflects on a time, early in her career, where prejudice played a role in her treatment of a patient.

I'd like to believe that I am not prejudiced. A patient's skin color, gender, age, or IQ should have no bearing on how I treat them. However, I remember a time, early in my career, where my belief was tested. I think of this patient sometimes and wonder how he ended up.

The first time I saw this patient was when he was 20 years old, and with his dark hair and blue eyes, he reminded me of my own son. He had no visitors.  I learned that his mother lived a thousand miles away and rarely visited. His father was not in the picture. The patient's history included drug use. One night, he was shot in the spine which left him paralyzed from the neck down. Living in a community nursing home, he ended up in the hospital several times a year with various types of infections.

I took extra time, when I could, to talk to him and encourage him. I helped bathe him when the nurses needed help. He rarely communicated with anyone other than to ask for pain meds or for someone to change the channel on the television. He had pressure ulcers on multiple areas of his body. The only movement he had was to be gingerly repositioned by his nurses. His limbs were contorted. He was thin and frail.

By chance, one day I was talking to a nurse in our department and I mentioned this young man. I told her my concerns for him. She looked at me with distain. “Really?” She asked, “Do you know what he did?” I told her I was aware of his drug history. She shook her head.  She had been in the courtroom when his case came before the judge. “He is a monster. There is no other word for it.” I inquired as to what she meant. “I don't know what you have been told but this man raped a four-year-old girl and almost killed her. He was there to baby-sit her while the parents were out to dinner. Afterward, he just left the baby alone. Can you imagine what her parents saw when they came home or the pain that little girl had to endure? The father of the baby and several other members of the family hunted him down. When they found him, they beat him, shot him, and left him for dead.”

In that moment, I thought of the child and the scars she would have both physically and psychologically. I could not look at him with the kindness I did before. I treated him, but I spent no extra time at his bedside. I started questioning myself. How could I have cared for someone who would do such a horrible thing?

By chance, his mother came for a visit. I met her and talked to her about her son's case. She decided she wanted to take him home and was trying to arrange a medical helicopter to transport him. I wondered what she felt about her son knowing what he had done. Given his declining health, I knew this would be best for them both. I knew his life would likely be a short one.

Although we must treat every patient, regardless of their illness or their past, I wish I could say that I gave it my all, but truthfully, I gave only what was required and nothing more. I learned the importance of being empathic without becoming emotionally attached.

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