By: Terrill Bravender MD, MPH; Editorial Board Member
|Department of Foreign Affairs
The Institute of Medicine’s landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century, stated that medical care should be more patient-centered. In order to achieve this, the committee recommended that physicians should become more responsive to patient needs and perspectives, and that patient values should guide medical decision making. For the most part this also is intuitive and self-evident. Of course we will help the patient who requests it to find a female (or male, or Spanish-speaking) physician.
What happens though, when a patient or family makes a request for a provider that we find particularly odious? For example, what if the father of a small child will not allow a Black provider to touch his daughter and requests a white physician?
The Ethics Rounds case presented in this issue of Pediatrics, from Reynolds et al. (doi: 10.1542/peds.2014-2092) describes such a case in the context of the historical discrimination faced by black medical providers in the United States, as well as identifying our current expectations for non-discrimination in employment and education.
The thoughtful discussion helped me come to a better understanding as to why I had such a negative visceral response to the father’s request, why I would accommodate a request in other cases, and what I might do if faced with such a request. Have you had similar requests from parents? How were you able to address such requests while still assuring appropriate care for the child?