Racism was once accepted as “part of the job” in clinical settings. There’s evidence this is changing.

getty

Fifteen years ago, I wrote an essay about an encounter I had as a resident physician with a patient who directed racist vitriol at me. I called it “The Racist Patient.”

I was advised not to write it.

Colleagues I respected told me it wasn’t wise. That it would be seen as unprofessional. That it might follow me. That medicine required a thicker skin. The implicit message was clear: experiences like this were real, but they were not meant to be named—at least not publicly.

The essay was rejected by several journals.

That, too, felt instructive. It reinforced the idea that while racism in clinical settings was widely experienced, it was not yet widely acknowledged. Eventually, the essay found a home in the Annals of Internal Medicine. To their credit, the editors recognized that what felt uncomfortable was precisely what needed to be surfaced.

I did not expect what happened next.

The piece struck a nerve. Physicians, nurses, and trainees wrote to me from across the country describing similar encounters. Many had never spoken about them openly—not with colleagues, not with leadership, and certainly not in print. What had been treated as isolated incidents revealed itself to be a pattern.

More importantly, it started a conversation that, at the time, simply wasn’t happening in most hospitals and health systems.

In the years that followed, something began to shift.

Health systems started to confront a question that had long been avoided: what are the obligations of a clinician when a patient’s behavior crosses the line from distress to discrimination?

Some institutions moved from silence to policy.

Organizations like the Cleveland Clinic and Mayo Clinic began to more explicitly articulate expectations around respectful behavior toward staff, embedding these standards into patient rights and responsibilities documents. The American Medical Association issued guidance affirming that physicians are not ethically obligated to comply with discriminatory patient requests for reassignment based on race or other personal characteristics.

Academic centers such as Mass General Brigham and UCSF Health developed escalation protocols—giving frontline staff clearer pathways to report incidents, involve supervisors, and, in some cases, transfer care when patient behavior became abusive. Some systems implemented “zero tolerance” policies for harassment, making explicit what had long been implicit: that professionalism is not a one-way obligation.

Even the language changed.

What was once described as “difficult patient behavior” began to be more accurately named—racism, harassment, discrimination. Naming matters. It clarifies what is happening and what is not acceptable.

These changes were not uniform, and they were not always well-executed. Policies on paper do not automatically translate into protection in practice. But they represented progress. They began to un-normalize behavior that had been quietly tolerated for generations.

And yet, fifteen years later, the story is not one of linear improvement.

If anything, the broader cultural context has grown more polarized.

The last decade has been marked by a coarsening of public discourse. The boundaries of what people feel permitted to say—openly, unapologetically—have shifted. Healthcare has not been insulated from this trend. If anything, it has absorbed it. Clinicians report not only racism, but a wider range of hostile behaviors: verbal abuse, threats, refusals of care based on identity, and a general erosion of baseline civility.

At the same time, there is less consensus about how to respond.

We are caught between competing imperatives. Medicine is, at its core, a service profession. We are trained to meet patients where they are, to understand the roots of their fear, anger, or confusion. But we are also human beings, and increasingly, organizations are recognizing that expecting clinicians to absorb abuse in the name of service is neither ethical nor sustainable.

The tension is real.

What has changed most, in my view, is not the presence of racism in clinical settings. It is the willingness to acknowledge it—and the growing insistence that it should not be endured in silence.

I think often about that moment as a resident—standing in a patient’s room, trying to reconcile my professional identity with a deeply personal affront. At the time, I felt alone in that tension.

Today, fewer clinicians feel that way.

They have language. They have policies—imperfect but real. They have, in some cases, leaders who will back them. And they have a clearer sense that professionalism does not require the quiet acceptance of dehumanization.

Fifteen years ago, I was told not to write that essay.

I am grateful I didn’t listen.

Not because the essay changed everything—it didn’t—but because it helped make something visible that had long been obscured.

Progress in medicine often comes through scientific discovery or technological innovation. But sometimes, it comes from telling the truth about what we experience at the bedside—and refusing to accept that certain harms are simply part of the job.

We still have work to do.

But we are no longer pretending that this conversation doesn’t belong in the open.