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07/24/2017

When a doctor calls a patient a racial slur, who is hurt?

by Keisha Ray, Ph.D.

Last week Lexi Carter, a black woman from Tennessee had an experience that so many other black people have had, a racially charged visit with a doctor. When Carter walked into her doctor’s office, Dr. James Turner greeted her with “Hi Aunt Jemima.” During the visit, he proceeded to call her Aunt Jemima more than once. Carter’s encounter with Dr. Turner is problematic for many reasons: 1. The term “Aunt Jemima,” which is the name of a popular syrup and pancake mix whose packaging depicts the face of a black woman, has a long history of racism dating back to the late 1800s; 2. Dr. Turner made these remarks in front a physician assistant trainee and a student who are still learning about the field of medicine; 3. After admitting to making the remark, Dr. Turner said that the term “was not intended to show disrespect for Ms. Carter,” calling it a “misspoken blunder.”

Aunt Jemima is a reflection of the “mammy” archetype that can be found in films, television shows, and literature (e.g. Calpurnia in “To Kill a Mocking bird” or Mammie in “Gone with the Wind”). The archetype depicts a larger black woman who is usually wearing an apron over a tattered dress, her hair is usually tied up with a scarf of some sort (typical of black slaves who tied their hair up to help protect from lice). The mammie character is also typically responsible for caring for the homes and children of white slave owners (i.e. house slaves), and who speaks using vernacular typical of uneducated black slaves, a vernacular that is usually mocked for being simple and unrefined unlike that of the vernacular of white people. As such, Aunt Jemima is also a reference to black inferiority and white superiority.

When Dr. Turner called Ms. Carter “Aunt Jemima” he was hurling the history of the term and its implications onto her because the history of words cannot be separated from their usage. As such it’s impossible for patients like Carter to trust a doctor who uses a racial insult when speaking with her when trust should be a pillar of the doctor-patient relationship. It would be understandable if Carter did not follow any of Dr. Turner’s treatment recommendations because he broke her trust and her confidence in his ability to do his job well.

Dr. Turner’s interaction with Carter is also troubling because he made the inappropriate remarks in front of trainees and students. Contrary to the well-intentioned beliefs of many lecturers and professors, most of the training for people hoping to enter the medical field happens in examination rooms. That’s where what they learned in the classroom is put into practice. Examination rooms are where they learn to navigate doctor-patient relationships. Simply, it’s where they learn how to treat people and they learn it from the physicians in charge of their training.  And because our courses do a very poor job of teaching students how to interact with patients of color, they learn how to interact with patients of color in examination rooms.

This is what scholars call the “hidden curriculum.” Students are constantly learning from physicians; they learn from their verbal teachings but they also learn from their actions and behaviors. The hidden curriculum is unspoken, as the name suggests. Physicians don’t say to students “See how I just treated this patient? You should do the same.” But just watching how physicians interact with patients can be just as meaningful and impactful as if they had verbally given them a lession. From watching physicians students learn the norms of medicine and if the physican uses racial slurs and inevitably treats some patients in biased ways that align with those racial slurs, students learn that this is normal and may do the same with their own future patients. In this instance students would be learning customs in medicine that, although are common, are instances of unethical and unprofessional behavior.

Lastly, Dr. Turner has said that he did not intend to disrespect his patient. Perhaps racism is so ingrained in medicine that he is incapable of seeing his actions as wrong. Although this is very plausible, I still find it very hard to believe that Dr. Turner had pure intentions with his remarks to Carter. At the very least he had to know that that the term Aunt Jemima is not a positive term. The doctor-patient relationship has an obvious power imbalance with doctors wielding power over their patients, even if unintentional. Because of this power imbalance it is the doctor’s responsibility to do everything possible to maintain the purity of that relationship.  Dr. Turner violated this relationship and did not live up to his professional duties with Ms. Carter. Even if I could believe that Dr. Turner did not intend to disrespect Ms. Carter, I choose to believe that Dr. Turner is a smart and educated man and at the very least he should have known that it would be inappropriate to refer to a patient by any name other than the name she has requested to be called. Like with many other situations, Dr. Turner’s intentions don’t matter here. What matters is that he knowingly called a patient by a name other than her given name and he violated professional protocol and basic human decency. Dr. Turner also contributed to a history of mistrust some black patients feel toward their non-black doctors as well as to medical racism, an ongoing issue in medicine that affects the quality of care black patients receive. When doctors act they are acting as representations of the entire field of medicine and Dr. Turner’s actions are a poor representation of the goals of medicine and a distraction from the good that many doctors across the world do every day.

I can imagine someone reading this and thinking “what’s the big deal? Is ‘Aunt Jemima’ really that bad?” And yes, it is. Words have meaning and regardless of intentions when we use words the meanings become attached to people and things in which we refer. This is even more problematic because doctors are supposed to be respected stewards of health. They are supposed to be the kind of people from which patients can receive good health care, something so vital to the success of life. Patients sign up for care, not insults when they choose to go to a doctor. Racial slurs are also distracting for the person experiencing them. It’s hard to concentrate on medical advice or even your daily activities, as Carter noted, when you’ve been called a racial slur. And yes, “Aunt Jemima” is a racial slur. It’s a racially charged term that is used for a specific racial group. Its usage is meant to send a very clear message to people; you are a part of a racial group that I consider inferior and you are not worthy of my decent and professional behavior. I acknowledge that doctors are fallible people just like everyone else and they have biases just like every person on Earth, but we should at the minimum expect them to keep their biases out of the examination room for the sake of patients and the profession.

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