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Patients still discriminate against health care workers of color. Why don’t more hospitals ban it?

When nurses and doctors experience discrimination from patients, everyone suffers.

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The tattoos on the patient’s body included “KKK” and “all of the things you would associate with being a white supremacist,” according to his assigned nurse, a Black man. The patient was a man with severe burns who said, “‘I don’t want any [racial slur] taking care of me.’”

The nurse, Ernest Grant, recalls thinking, I can’t believe this is happening.

This was roughly 20 years ago, before Grant would become a national leader in the profession as the first male president of the American Nurses Association. Yet, Grant says he would not be surprised if it happened today.

It does. In a nationwide survey of nearly 1,000 nurses conducted in April and May by the Robert Wood Johnson Foundation and NORC at the University of Chicago, 8 of 10 nurses said they have experienced “a high prevalence of racism and discrimination” from patients. In a 2017 survey of over 800 doctors co-led by health care website STAT, more than 20 percent said a patient had requested a different clinician based on race.

To me, the idea of a white patient refusing care from a Black practitioner seemed straight out of the 1950s until I heard a conversation a few years ago between Grant and my former colleague, Lawana Brown, a nurse practitioner with the University of South Carolina Student Health Services and an assistant professor at Regis College. In a discussion on the Nurses’ Station video series (now a podcast), Brown shared an early experience she had with a patient as a labor and delivery nurse. “In the middle of me getting ready to triage her, she said that ‘I don’t want a Black nurse. I want a white nurse. Get me somebody else.’ You have little nuances of racist patients, but this is the first one who said, ‘I don’t want you.’”


Not all requests for providers of a particular ethnicity or gender are discriminatory. It’s understandable why a female patient might be more comfortable with a woman as a physician, for example, or how language barriers and cultural differences could prompt a patient to request a provider from their ethnic background.


When a Black patient requests a Black provider, it might be rooted in their knowledge of the medical profession’s notorious past. The Tuskegee syphilis study begun on Black men in 1932 was perhaps the most infamous historical example of racism in medicine, though inequities and ignorance persist. According to a study by University of Virginia researchers published in 2016, about 40 percent of first- and second-year medical students believed that Black people had thicker skin than white people, a myth that led practitioners to believe that Black patients have a higher tolerance for pain and a lesser need for relief.

Patients who reject an individual strictly based on fears and paranoia aren’t simply making a personal choice: Their requests have an impact on health care for everyone. That 2017 STAT survey, conducted in collaboration with WebMD and Medscape, also found that among Black and Asian physicians, around 70 percent of respondents reported hearing biased remarks from patients.

Patricia Illingworth, a lawyer and professor of philosophy and business with the Ethics Institute at Northeastern University, says hospitals should have a zero-tolerance policy for accommodating race-based patient requests, with the exception of patients diagnosed with post-traumatic stress disorder or some other kind of trauma. Having served on ethics committees for Boston hospitals, she concludes that “we need to be stricter with these kinds of policies.”


Health care workers have won lawsuits against hospitals that have complied with discriminatory requests. The fact that employers were motivated not by any racial animus of their own but by the desire to please patients shouldn’t let them off the hook, according to Thaddeus Mason Pope, a law professor at the Mitchell Hamline School of Law. By accommodating the patient’s preference, “The institution becomes the discriminatory agent,” he wrote in The ASCO Post, a newspaper for members of the American Society of Clinical Oncology.

The code of conduct developed by the Massachusetts Health & Hospital Association as a framework for its members includes “threatening, discriminatory, bullying, disrespectful or offensive language” as possible violations, but does not specifically mention race-based requests from patients regarding providers.

So why don’t more hospitals prohibit the practice? I contacted three large medical groups and Boston Medical Center. Only one, Beth Israel Lahey Health, explicitly bans “refusing care based on the race of an employee” in their patient codes of conduct.

Providers don’t get to choose their patients. In nursing, says Grant, who is currently interim vice dean for diversity, equity, and inclusion at Duke University School of Nursing, “Our code of ethics is to treat that individual regardless of their thoughts or prejudices.” But ambiguous policies on race take a toll on practitioners, who may choose to leave the profession; on hospitals already facing staff shortages; and potentially on outcomes for patients like Lawana Brown’s. Her patient chose the only other nurse available, who was not from the labor and delivery department, instead of a seasoned specialist.


In that uncomfortable moment two decades ago, Grant recalls, his patient received three options. One was to remain at the hospital and get the best quality care from Grant. Two, they could give him medications and materials to clean his burns himself before discharging him, possibly resulting in having to be readmitted later. Three, he could travel to the nearest burn center 68 miles away, where he would likely encounter the same options from the staff there.

Grant’s patient ultimately made the wise choice: He decided to stay and receive the best treatment from the most qualified nurse.

Andy Levinsky is a frequent contributor to the Globe Magazine. Send comments to