Bigotry in Medicine: Facing Conflict with Empathy

Life has a funny way of throwing all sorts of unexpected things your way.  We physicians deal with this regularly.  You never know what’s lurking around the corner, ready to raise its ugly head just to put a huge dent in your day.  Fear also emerges in various forms—an unintended consequence while treating a patient or a potentially disastrous event during a surgical procedure.  Fear rocks your very core.
Then there are circumstances that inflame your passions, striking a nerve and driving you to respond with fire, particularly when unpleasantries such as bigotry or racism arise and slap you square in the face.
And then again sometime in your career you’ll no doubt experience both bigotry and fear all in one tidy package, no less in the form of a very threatening, prejudiced individual.  Stand your ground, hold fast to your principals, but rather than spontaneously responding with ire, take a step back and first seek to see things from your adversary’s position.  Respond not by telling him how wrong he may be, but by standing in his shoes and responding from his perspective, allowing him to shed the light on the error of his ways.  This is easier said than done.  But doing so may diffuse a hostile situation and save you a black eye, and may even win him to your way of thinking.  It’s all in the attitude.  How you respond is a matter of choice.  I learned this early in my medical training.
I was a first-year resident in otolaryngology in the summer of 1991 and only a month or two into my ENT training.  My first assignment was the VA Hospital in Milwaukee, Wisconsin where I met a very unhappy patient in our clinic.  I approached him, introduced myself and offered my hand.  He would not take it. 
As a na├»ve young doc, I repeated the introduction and kept my hand out.  He stared at my hand.  He then lifted his gaze and stared me in the eye.  An uncomfortable silence followed.
“I used to shoot people like you,” he finally said.  I withdrew my hand and did something with it, perhaps straightening my tie or using it to fumble about in his chart.  I forget the details.
I froze in fear.  Two things entered my head: 1. “Holy Crap!” and 2. “My God, he’s gonna kill me!” 
I should’ve been outraged by this remark, I suppose.  Instead, I was scared stiff, like a deer caught in the headlights.
He persistently stared.  He then continued, “It’s because of you people that I got wounded.”  He leaned a bit forward.  “But I shot and killed a bunch of you!”
I wanted to bolt for the exit but I couldn’t move my legs.  I wished to disappear, to make myself invisible, but alas as I discovered many-times as a kid during frightening or embarrassing circumstances, all the mind-power I could muster could not make it so.  I simply stood there like a fool, confounded, at a complete loss for what to do or say.
“What do you say about that?” he finally said.  I gathered the silence must’ve been killing him but not to the extent it was killing me.
It dawned on me that he was a Vietnam vet.  I’m not Vietnamese, but I figured arguing from that perspective would not matter.  I still was an Asian.  I knew I’d encounter patients like this in one form or another as a doctor—I understood this was just part of the calling.  But reality has a funny way of bringing to light the direness of frightful circumstances since it is so…real, and far greater than once imagined.  And so this threw me for a loop, so to speak—a really big loop. 
After the tremors and the urge to faint passed, I reckoned I should perhaps stand my ground, knowing he could punch the living daylights out of me.  The one positive consequence was that if I were injured really bad, the senior resident wouldn’t make me take call that night.
“I don’t understand,” I finally muttered.  “You shot other Americans?”  This was the best response my brain could assemble on the spot. 
His face reddened and his eyes bulged.  Already I regretted my approach.  “No!  I used to shoot people like YOU!  People who came from where YOU came from!” he pointed a gnarled finger at me.  It was a rather big finger.  A finger that could inflict a world of hurt.
Motionless and frozen I remained, feeling like one of those ice sculptures in the middle of a buffet table, slowly degenerating into an unrecognizable, amorphous mass.  He was one scary vet.  He was big but his hostile expression only multiplied his scariness.  My eyes focused on that gnarled finger still pointing at me, a deformed appendage unable to extend itself completely but was just as ominous as the fellow possessing it.  I figured he could whack me upside the head with that finger and send me flying through the window into the garbage dumpster of spoiled food and moist cigarette butts six stories below.  Not knowing what to expect, I stuck to my original tactic.
“You mean, you used to shoot people from California?”  Provoking him was the last thing on my mind and I honestly was not trying to be a wise-ass.
“Are you being a wise-ass, boy?” he leaned forward.  I held my ground not so much as a matter of courage, but instead through paralysis by fear, though I believe my chattering teeth were the only things moving in my body.
“Uh, I’m from California,” I replied meekly.  “I was born in California.”  Then as an after-thought I stupidly added, “Uh, aren’t Californians Americans as well?”
 “No, no!” he shouted.  “I mean, yeah!  You know what I mean!  I shot gooks like you in Vietnam!”
I was stuck. But then a little lightbulb flashed above my head, showing me a possible escape, a sort of counter-strategy that might work well or completely backfire and land me with a broken nose and a bunch of missing teeth.  I figured I was already in pretty deep with this guy, so I took the risk.
“But I’m half-Japanese,” I countered, “I thought we’re allies now with the Japanese.”
He gave me the same stare, with blood-shot eyes.  “Half Jap?” he said.  “What’s the other half?”
“Uh, Chinese.  Weren’t we allies with the Chinese during World War II?  I know they’re a bunch of Commies now, but that’s not my fault.  My parents were both born in the U.S.  My grandmother was born in the U.S., in Los Angeles of all places.  And this is the farthest I’ve been from home.  Never been to no Asian countries, let alone Vietnam.”
“Oh yeah?”
“Yep.  Never been outside the U.S.  Well, I did go to Tijuana, Mexico once.  It’s just across the border, south of San Diego.  You probably know that.  The border patrol almost wouldn’t let me come back—thought I was a Mexican or something.  Or maybe they thought I was a Chinese Communist trying to sneak into the country through Mexico.  I really don’t know, never went back to ask.  I was just glad to be back home.  Never went to Tijuana again.”
He chuckled.  This seemed to soften his demeanor and oddly his attitude slowly changed.  We talked a little more and he eventually allowed me take his history and do the exam.  As it turned out, the poor guy had cancer.
We got along just splendidly from then on.  When he presented for his follow-up appointments, he’d shout, “I’m here to see Dr. Fong!  Where the hell is he?  He’s my doc!”    He was reluctant to talk about Vietnam, but now and then revealed a little about his tour there, where he lost a friend during combat, blown to pieces by a grenade.  I understood how his hatred for people who looked like me came into being.  Looking back, I like to think we both were better people having met one another.  My only regret is that I’ve forgotten his name.
The moral of this story?  I successfully—though with a bit of dumb luck—diffused a potentially explosive engagement and turned it into one that benefitted us both.  It’s easy to respond with an equal degree of animosity, but countering like with like will not win your adversary to your side, is doomed to fail, and may very well escalate an already bad situation into something far worse.  You have the freedom to choose the way you handle any conflict.  The power truly and ultimately lies in your hands.  It’s another application of empathy, that time-honored quality we doctors are supposed to possess.  Understanding another’s mindset and tailoring your approach in a more open--and sometimes unorthodox--manner can make all the difference.

©Randall S. Fong, M.D.


  1. In the comedy world, this man would be labeled a “heckler” and you did an awesome job of diffusing the heckling situation. You steered him to say “out loud” his complaint against you. I love it when you said “You shot other Americans?” Then “Californians?” Etc. You diffused the hostility so masterfully. You didn’t REACT by being angry, but by finding a way to “educate”. Being a female English-Irish-Afrik-kan American Anesthesiologist , I too have met hecklers of this ilk, but just as you did, turned an adversarial relationship into one of mutual respect. Kudos Dr Fong!


Post a Comment