Inside NYP: Dr. Renuka Gupta
The hospitalist and assistant professor talks about a problem rarely discussed in healthcare: What doctors should do when confronted with racist behavior by a patient.
I grew up in a conservative, middle-class family in India. No one was a physician, but from the time I was 4, my dad had the idea that his daughter would be a doctor. I grew up with 13 male cousins. I was the only girl, and my parents had very high hopes for me.
I was a little too extroverted. I did things Indian girls are not supposed to do, like climbing trees. Later, I caused a ruckus by secretly enlisting in the army. When I was growing up, the goal, for many women in India, was to get educated, but also to learn how to cook, and to get married to a man from a good family. But my dad said, “No, no household work. She needs to study and become a doctor.”
I arrived in New York City 15 years ago, repeated my residency, and did an additional year of training in clinical nutrition at NewYork-Presbyterian/Columbia University Irving Medical Center. I was struck by how patients in the States really talk to their doctors and ask questions. In India, including in the army where I was a captain, doctors would do the talking and patients took the information in. So I had to get used to that difference.
I’ll admit, I felt intimidated when I started working at NewYork-Presbyterian/Weill Cornell Medical Center as an attending. Most of my colleagues were from elite university backgrounds, and while I felt very supported by my division chief, Dr. Arthur Evans, I had a tendency to doubt myself. It was a big change for me because I trained in an Asian community, and when I came here, I was dealing with people from many cultural backgrounds.
I was surprised, working at such a prestigious institution as NewYork-Presbyterian/Weill Cornell, how often I had patients say, “I don’t want to see you.” Or say, “Get me an American doctor.” As a woman of color, I felt there was excessive scrutiny of my physical appearance and the patients would often direct their questions to someone else. I was usually successful at brushing these incidents off.
But one Monday morning a few years ago, these strategies did not work. While doing my usual patient rounds with my team, I had an encounter with a patient that really shook me. I said hello and introduced myself, and he asked where I was from, and where I’d gotten my training. I was used to this, but what he said next surprised me: “When I went to grad school, there were no Indians at all,” he began. “And how could there be? You were all still slaves then.” As I tried to contain my shock and anger, he told me he wanted another doctor.
Then, the patient, who was an attorney, said, “I can sue you and get your license revoked, and you will lose all your privileges. I am surprised that the hospital hired you. I am sure they had better options.”
I couldn’t believe what I’d heard. Afterward, my heart was pounding. I knew I was supposed to be a role model and teach the residents, physician assistants, and others how to handle difficult problems. But I couldn’t bear to let anyone see me, so I locked myself in the bathroom and sobbed. Then I left the floor.
After the incident, I’d sometimes overhear residents talking about it. Then, the chief of residents asked me if I’d be willing to talk about it with over 30 residents during a lunch-time conference. It took courage to say yes to that — I had to force myself.
But to my surprise, opening up during that lunch felt cathartic. After I spoke, residents started talking about their own experiences facing racism. For the first time, I didn’t feel so alone.
That experience made me wonder why we didn’t have a regular place or forum for that kind of discussion. I wanted to create opportunities for people to feel safe talking about these emotionally charged topics, rather than keeping things bottled up. I think most doctors and staff — especially doctors in training — are apprehensive about discussing inappropriate behavior, whether the behavior is from patients, colleagues, or supervisors. And then I learned that an ombudsman is someone who specializes in these situations and assists individuals and groups in resolving conflicts, regardless of a person’s rank or position. I decided to take a course in ombudsman training.
Now, I’m working on an ombudsman initiative with Dr. Laura Forese, executive vice president and chief operating officer of NewYork-Presbyterian. She has been an inspiring mentor and a champion of a respectful working environment. I don’t want anyone else to have the kind of heartbreaking encounter I had and have no one to talk to.
It’s important to foster an environment where doctors and staff feel safe, where they don’t feel discriminated against. Just a few days ago, a patient told me, again, “I don’t want to see you. I want an American.” But now, I handle that kind of experience differently. Instead of bottling up my emotions, we’ll discuss within the department, and if it makes sense, we will transfer care to another doctor. Just as important, I’ll sit with my team, talk about it with residents and colleagues, and we all share our feelings. And I tell people, “Please, if you go through this, spend five minutes to talk about it.” I don’t want anyone to shut themselves in the bathroom, thinking they did a bad job.
Since I’ve opened up, faculty, staff, and residents around me have gotten more comfortable opening up. As doctors, we also need a place where we can share our experiences.
Often, new residents and medical students will ask, “Was that OK?” or “How should I have handled that situation?” For all of us, it’s good to feel like someone is supporting you with open arms, someone is saying, I’m here with you. We all need to feel comfortable speaking up to say racism is never OK.
Dr. Renuka Gupta is a hospitalist who cares for hospitalized patients and does not have an outpatient practice. Board certified in internal medicine, she has been on faculty at NewYork-Presbyterian/Weill Cornell Medical Center nine years and is an assistant professor of medicine at Weill Cornell Medicine. In addition to her inpatient clinical work, she also works as a physician liaison with NewYork-Presbyterian leadership. Her academic interests include clinical nutrition, hospital operations, patient and staff satisfaction, teamwork, and communication.