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No Room For Ignorance in Medicine

Doctors who do not accept all patients, regardless of race, nationality, sex, sexual orientation, social or economic status, in my opinion, are in the wrong profession and should simply not be seeing patients. Recent behavior by one physician at a local medical CME conference made me want to express my opinion about this. Today we live in a country highly divided in political views but politics and personal opinions should not flow into our medical practice which effects so many individual lives. Immigration is a big topic today that led to a recent government shutdown and what happened at this conference obviously stemmed from a personal bias of one physician who decided to express his opinion publicly. At a recent physician conference on preventing medical errors there was an interesting case presented about a preventable complication that stemmed from a way a prescription was written to a (mostly) Spanish speaking patient. The script was for digoxin (medication used to prevent cardiac arrhythmia like atrial fibrillation, but also toxic to the heart if too much is taken). Physician decided to write directions as “take once daily.” It may seem like a perfectly good statement to most, meaning, take one pill (or tablet) on a daily basis. However, this patient interpreted “once” as the Spanish ‘once’ meaning eleven (11). Patient took eleven pills all at once and went into cardiac arrhythmia requiring cardioversion and hospitalization in the ICU. At this point one physician in the audience stood up and actually had enough stamina to arrogantly say: “this patient should have learned English since they live in this country now. It is not the doctor’s fault the patient did not speak English well.” Or is it? As ignorant as this comment is, the doctor is indeed at fault here too. Doctors are taught as early as medical school to write out prescriptions in full sentences. Instead of “take once daily,” the script should have been written in detail as “take one pill every day,” or “take one pill one time per day.” This patient had a language barrier that should have been recognized by the physician. But the most striking thing to me about this was that this comment was made by an actual physician taking care of all kinds of patients. How you can treat someone and make these types of comments is completely absurd to me. We are professionals who are privileged to do what we do and should do so humbly and respectfully. One Spanish-speaking family once expressed to me how concerned their own family and friends are about seeking medical help in United States already because of the fear of being poorly understood, not understood at all, or misinterpreted. We should not, by any means, make this even harder on them. I was recently reminded and quite frankly embarrassed by someone mentioning that citizens in Europe can speak up to 7 languages, and here we barely get by with one and expect everyone else to learn it too. Medicine is supposed to be a noble profession led by highly educated people who are knowledgeable not only in medicine but also culture, diversity, and professionalism. What that physician said at the conference was not professional or respectful in any way and I am embarrassed for him. I hope that by writing this I can remind the rest of us of our obligation to patients (of all backgrounds) and their civil right to fair treatment and the best care we can give. Let us leave political or personal opinions at home, remain professional in our behavior in public, and continue to provide highest quality medical care to all our patients.