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Scenario 019: Registration staff member refers to a Native American patient as “Chief”

Scenario 019: Registration staff member refers to a Native American patient as “Chief”

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Scenario:

The patient, Mr. Stevens, is a Native American man, who is speaking to registration staff. The staff member is a white man who reviews their paperwork and when finished says, “You’re all good now, Chief.” 

1) Impact: How might this interaction affect the individuals involved?  Who might it harm? Why? Why does this matter? 

  1. Calling a Native American person “chief” is inappropriate and potentially offensive.  Although each person is different and we do not know exactly how this will land on the patient, using the term “Chief” to refer to a Native American person in everyday settings is often seen as a harmful, inaccurate stereotype.  It is quite possible that the young man is used to this sort of thing, but that does not make it acceptable to continue the practice.  
  2. Given the history of our country, Native American patients have a lot of good reasons to distrust our medical system. Even what you may feel is a minor insult, like this example, may contribute to a person feeling that this medical system is not designed for them, and they are not welcome here.  For almost all of us, our names are very important to our identity.  We should all get in the habit of respectfully referring to each other with our actual names.  In this case, the staff member should have referred to the patient as Mr. Stevens. 

2) Intervention: If you were to intervene to address the potential harm caused… 

  1. What might you do or say? 
    1. You may say to the staff member, “Please, you should refer to people by their actual names. I am sorry about that, Mr. Stevens.”
    2. You may say to the staff member, “Let’s not refer to him as Chief, it is potentially offensive.”  Note: Some may wonder why we hedge with the word “potentially” as it may seem obviously offensive to you.  We want to respect that the offense is really within the experience of Mr. Stevens, and although he likely would be offended, every individual is different and will react differently. 
    3. You may talk to the staff member afterwards and explain to them why it is inappropriate. 
    4. You may find Mr. Stevens afterwards, apologize for your colleague, and ask him if he would like you to say something to your colleague. 
    5. You may tell your supervisor about the incident.  
  2. What obstacles might get in the way of you intervening? 
    1. You may not know what Mr. Stevens wants and not want to step in and speak for him if he doesn’t want your help. If this is the case, you could still approach him afterwards and check with him. 
    2. You may not realize this is an insult or assume that the staff member did not know it was insulting.  After all, isn’t referring to someone as “Chief” a fun, informal way of showing respect to someone?  If this is the case, you may say to the staff member, “I am guessing you were just trying to be friendly and respectful, but you really shouldn’t jokingly refer to a Native American person as Chief.” 

3) Repair: If you are the “offender”, how can you apologize or accept feedback? 

  1. You may say, “I was trying to be friendly without really thinking.  That was inappropriate of me. I apologize, Mr. Stevens.” 
  2. You can share a commitment to educating yourself better about cultural sensitivity to avoid these mistakes in the future 
  3. Consider the broader implications of such language and how it affects relationships within the community. 

4) More Information: Additional comments and background information about this scenario:

  1. There is an important history and cultural context to this issue that many people may not know.  First, Native American tribes have never used the word “Chief” to refer to their leaders. Different tribes have their own terms for their leaders which do not translate directly to “Chief”.  It is a European term that was first applied to Native leaders by colonizers.  This makes it particularly offensive to direct this term towards a Native American person. To learn more, see this article here.  Of course, even if it was an Indigenous term, it would not be acceptable to refer to the young man in this way.   
  2. This insult can be seen as an example of both “objectifying” and “stereotyping.” 

Scenario 001: A patient’s brother says something Islamophobic to a team member

Scenario 001: A patient’s brother says something Islamophobic to a team member

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Scenario:

You are in a room with a patient, the patient’s brother, and the Patient Care Technician, Jamila, who wears a hijab. The brother asks Jamila, “Does your husband make you wear that hijab?” 

1) Impact: How might this interaction affect the individuals involved?  Who might it harm? Why? Why does this matter? 

  1. The PCT likely feels unwelcome and othered for her choices. She probably feels like the Patient’s brother assumed things about her religion and autonomy based on her clothing. She might feel the need to justify or explain her beliefs and background in order to defend herself. Her role as someone who cares for the patient might also make this an awkward interaction. 
  2. How it impacts her will of course depend on who she is as an individual and how she has learned to cope with these sorts of experiences.  In general, such an experience – combined with other insults and slights that accumulate over time – may contribute to higher burnout, less feelings of inclusion and belonging, stress, depression, and lower levels of job satisfaction.  

2) Intervention: If you were to intervene to address the potential harm caused… 

  1. What might you do or say? 
    1. “That is disrespectful to Jamila. Can we focus on your sibling’s care instead?” 
    2. “I am curious why you are asking her that question/saying these offensive things”   
    3. You could let Jamila have a moment and step outside if she would like. You could also approach her afterwards, tell her you noticed the comment or question, and ask her if she would like you to speak up if something like that were to happen again. You could provide her with some validation that such experiences are unfair and possibly exhausting, and you could offer her your genuine appreciation for her. 
    4. You could approach the patient’s brother afterwards and explain their mistake to them. 
  2. What obstacles might get in the way of you intervening? 
    1. You may feel that the incident happens too quickly for you to figure out what to say or do.  Then it becomes awkward for you to say something.  
    2. You may be unsure what Jamila would want you to do.  Maybe she does not want you to intervene on her behalf?  In this case, you could still talk to her afterwards, ask her what she would have wanted, and offer validation. 
    3. You may not want to interrupt or distract from the urgent clinical care of the patient. In this case, you could still talk to the individuals involved afterwards. 

3) Repair: If you are the “offender”, how can you apologize or accept feedback? 

  1. You may say, “I’m sorry, that was an inappropriate question based on stereotypes. I’m sorry, Jamila.”  We include this option because such an apology would likely be received as a very meaningful and authentic, although we also recognize that it would be hard for an offender to recognize and admit to this bias so quickly.  There is a skill to apologizing that is hard for most of us to achieve.  The best apologies are ones in which the offender takes direct responsibility for their behavior that caused the harm, as in this example. For more information on apologies, consider this excellent book. 
  2. You may say, “I’m sorry Jamila, that was rude of me to ask” 

4) More Information: Additional comments and background information about this scenario:

  1. This scenario may bring up important discussions about Islamophobia and stereotypes. 
  2. This scenario may also bring up discussions of intersectionality. Intersectionality is a framework used to understand how a person’s experience is a unique combination of their social and political identities. This combination can be both privileged and marginalized at the same time. In this case, although Jamila was a Muslim and a woman. 
  3. Although this may feel like a minor insult, it is important to understand the very real effects of Islamophobia that made it very hard for Muslim individuals to navigate their lives in this country. 

Scenario 022: An attending repeatedly misgenders patient 

Scenario 022: An attending repeatedly misgenders patient 

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Scenario:

The Attending, a cis woman, is talking to the MAs, CNAs and RNs about a patient in the other room. As she talks about the patient to the ED team, she misgenders the patient several times and others respond by using the patient’s correct pronouns. The attending does not seem to recognize these moments and does not change her language in subsequent conversations. 

1) Impact: How might this interaction affect the individuals involved?  Who might it harm? Why? Why does this matter? 

  1. Although the patient is not in the room, this incident still needs to be addressed.  Being misgendered can make a person experience feelings of invalidation and distress, as being misgendered can deeply impact their sense of identity and belonging. This matters because patient dignity and respect are fundamental to quality care. People in our community who have experienced this microaggression have expressed concerns that providers not getting their pronouns right cannot be trusted to take care of their health. Not acknowledging a patient’s identity can erode trust in the healthcare system. 
  2. While the patient is not present, there may be staff or providers in the room who may also have a gender identity that is marginalized. It can make those people feel like they do not belong. It can also erode the trust within the healthcare team and damage interpersonal relationships. 
  3. The Attending might not be aware or realize that the rest of the team is responding with the correct pronouns in order to correct her. She might not even be aware of her impact. However, repeated misgendering can lead to feelings of frustration and discomfort. Other members of the medical team may worry about her interactions with the patient, feeling compelled to advocate for respectful treatment while also navigating their relationship with a senior physician. This can create a challenging dynamic, as they may feel caught between supporting the patient and respecting authority  

2) Intervention: If you were to intervene to address the potential harm caused… 

  1. What might you do or say? 
    1. You could interject during the meeting, saying, “Just a reminder, the patient uses [correct pronoun].” This reinforces the importance of using the correct pronouns and explains to the Attending without creating a confrontational atmosphere  
    2. You could work to create a system where all people in the room have their pronouns in view including the patient with a sticky note or white board. 
    3. After the meeting, you might approach the Attending privately, acknowledging that correcting someone in front of a group can be uncomfortable. You could say, “I noticed that you misgendered the patient earlier. I know you appreciate the importance of remembering their pronouns to provide the best care, so I want to share this with you respectfully.” 
    4. You could also advocate for creating a more inclusive environment by suggesting team training on gender identity and the importance of pronoun usage. 
    5. You may tell your supervisor or document using the bias reporting form.  Note: You may be concerned that this would potentially constitute an escalation. First we do not want to encourage the every-day use of this response as an intervention strategy, but it is important and appropriate in specific contexts, especially if other strategies have failed and the problem is continuing.  Also, it should be understood that a report to the bias reporting tool (BRT) does not automatically produce an HR or other disciplinary response.  The BRT committee explores each report as a unique instance and does not escalate to an investigation or possible discipline unless appropriate.  They aim to respond to each report restoratively, maintaining strong working relationships among those involved as much as possible.
  2. What obstacles might get in the way of you intervening? 
    1. You may worry that explicitly correcting a senior physician could lead to negative consequences for your standing in the team or even your career. 
    2. In addition, you may worry about doing this in front of other members of the team. 
    3. You might worry that your correction could be misconstrued as an overreaction, leading to more misunderstandings or awkwardness. 

3) Repair: If you are the “offender”, how can you apologize or accept feedback? 

  1. You could say, “I apologize for repeatedly misgendering the patient; I appreciate your corrections and will educate myself more on this topic.” 
  2. Engaging in training regarding the importance of respecting patient identities, demonstrating a willingness to learn and grow from the experience 
  3. You could say “I’m sorry I was dismissive of the patient’s pronouns. I will make a note on my sheet so I can practice getting it right”  

Scenario 037: A provider gives a backhanded compliment about a Latina RN’s articulateness

Scenario 037: A provider gives a backhanded compliment about a Latina RN’s articulateness

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Scenario:

In a busy clinic, a provider leans on the counter and says to Lucy, a Latina RN, “How did you get so articulate?” 

1) Impact: How might this interaction affect the individuals involved?  Who might it harm? Why? Why does this matter? 

  1. The RN may feel insulted by this comment from the provider.  Although it may sound like a compliment, it also shows that the provider is surprised that the RN is a strong and effective communicator. This suggests that the provider feels it is unusual for someone of the RN’s background to speak as she does, reinforcing harmful stereotypes about linguistic ability, intelligence, and education tied to ethnicity or race. Thus, even as the comment may be a compliment to the individual, it is an insult to their ethnicity or race.   
  2. This kind of comment may be seen as an example of “counter-stereotypical surprise,” similar to wondering how an Asian person became good at basketball or a Black person got into law school, or saying “you don’t seem gay!” to a gay man.   All of these compliments require an acknowledgement of a negative stereotype for the compliment to succeed.  
  3. The impact of this comment will depend on the RN’s experiences, resilience, and workplace environment. If she has faced similar comments or microaggressions in the past, it may compound feelings of marginalization or frustration. The workplace culture also plays a critical role; if it is inclusive and supportive, she might feel more empowered to address or dismiss the comment. Conversely, if the culture tolerates such remarks, it could contribute to a hostile environment, reducing morale and trust. 
  4. For bystanders or other staff, this interaction might also signal tolerance for biases, even if subtle, which could affect the broader sense of psychological safety within the team. 

2) Intervention: If you were to intervene to address the potential harm caused… 

  1. What might you do or say? 
    1. You may say to the provider, “That comment doesn’t sit right with me. Assuming she wouldn’t be articulate feels a bit offensive.” 
    2. Alternatively, you might choose to check in with the RN privately after the incident. You could say, “I heard that comment about being ‘articulate.’ How are you feeling about it? Would you like me to address it?”  
    3. If the RN expresses discomfort and encourages you, it might be worth addressing with the provider later. You could say, “I noticed your comment earlier. While I’m sure you didn’t mean harm, it is conveys a negative stereotype.” 
    4. If the provider has a pattern of making similar remarks, you could choose to discuss with a supervisor.  
  2. What obstacles might get in the way of you intervening? 
    1. You may worry that addressing the comment could create conflict or make the provider defensive.  
    2. You might hesitate if you are unsure whether the RN found the comment harmful or whether she would prefer to handle it herself. To overcome this, you could ask the RN privately how she prefers to handle situations like this. Building a culture where feedback is welcomed and sensitivity is valued can also reduce hesitation over time. 

3) Repair: If you are the “offender”, how can you apologize or accept feedback? 

  1. You may say, “I want to apologize for my comment, I realize now that it was reinforcing of stereotypes. Really sorry, you deserve better than that from me.” 
  2. You may say, “You are right, I shouldn’t have asked that.  I am sorry I did.  I appreciate you, Lucy.”  

4) More Information: Additional comments and background information about this scenario: 

  1. This particular comment has an interesting history, especially when applied to Black people.  The comment gained mainstream attention in 2007 when Joe Biden referred to Barack Obama as “clean and articulate” when they were campaigning together for President and Vice President.  See here for more information:  https://www.nytimes.com/2007/02/04/weekinreview/04clemetson.html 

Scenario 023: A patient makes sexualizing comments about his nurse 

Scenario 023: A patient makes sexualizing comments about his nurse 

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Scenario:

The nurse is a woman named Jasmine. She is getting the new patient Andrew, a man, into a gown and on the monitor. The resident asks Andrew how he is feeling. He responds, “Much better now that I have this pretty lady with her hands on me!”

1) Impact: How might this interaction affect the individuals involved?  Who might it harm? Why? Why does this matter? 

  1. Andrew’s comment can create an uncomfortable dynamic for Jasmine, who may feel objectified, sexualized or disrespected in a professional setting. It might qualify as sexual harassment, but that is beyond our discussion.  It may undermine her role as a healthcare provider and shift the focus away from the patient’s medical needs to a more personal and inappropriate context. This can lead to feelings of frustration and diminish her confidence in the workplace. 
  2. For the resident, the patient’s remark may elicit a sense of discomfort as well, especially if he feels that it undermines the professionalism of the environment. He may worry about how to respond appropriately, feeling caught between maintaining rapport with the patient and supporting the staff. 
  3. The patient may not realize the implications of his comment, which can normalize a culture of casual sexism in healthcare settings. This matters because such remarks can contribute to a toxic environment that impacts the well-being and morale of healthcare staff, ultimately affecting patient care and the overall quality of the healthcare experience. 

2) Intervention: If you were to intervene to address the potential harm caused… 

  1. What might you do or say? 
    1. If you are the resident, you could respond directly to Andrew, saying, “That’s inappropriate and we do not tolerate that talk here” or “let’s keep our conversation professional”. You could follow that up by adding “It’s important that we focus on your care”. This can set clear boundaries while redirecting the conversation. 
    2. You could also say something brief in the moment, and then follow-up with a discussion with the patient later.  This may allow you to give feedback to the patient in a more effective way.   
    3. After the interaction, you might approach Jasmine and say, “I noticed that comment made by the patient. I just wanted to check in with you and see how you’re feeling about it.” This offers her support and validates her experience. 
  2. What obstacles might get in the way of you intervening? 
    1. You may worry that addressing the patient’s comment could lead to an uncomfortable confrontation or escalate the situation unnecessarily or damage rapport with the patient. 
    2. As a team member, you may question whether it is your place to correct the patient or intervene in Jasmine and Andrew’s interaction. 
    3. The resident’s position as a more senior member of the team can create a power imbalance, making it difficult for you to intervene without feeling subordinate or anxious about how your correction might be perceived. 
    4. You may be concerned about creating an awkward atmosphere for Jasmine, the patient, or anyone else present. You may also worry that your intervention could be perceived as culturally insensitive, depending on Jasmine and Andrew’s background or expectations. 

3) Repair: If you are the “offender”, how can you apologize or accept feedback? 

  1. You might acknowledge the discomfort your comment caused and say something like “I’m sorry. What I said was inappropriate. I was trying to be funny but ended up making you uncomfortable and I apologize”. This shows awareness of the impact of your words and a willingness to take responsibility. 
  2. You could also say something like “I realize now that my joke wasn’t appropriate. I didn’t mean to objectify anyone, and I apologize for that.” 

4) More Information: Additional comments and background information about this scenario: 

  1. This scenario highlights the importance of professionalism in patient interactions and the need to create a respectful environment for both staff and patients. It underscores the necessity for training on appropriate communication and boundaries in healthcare settings. 
  2. It is crucial to prioritize Jasmine’s sense of safety and well-being in this context. Objectifying comments can contribute to a toxic work environment, making staff feel uncomfortable or devalued. Ensuring that all team members feel respected and supported is essential for their mental health and job satisfaction. Prioritizing Jasmine should be the most important concern. 
  3. Addressing comments that objectify or undermine healthcare professionals is vital for fostering a culture of respect and ensuring that all staff feel valued and safe in their roles. Open discussions about boundaries and professional conduct can enhance the overall quality of patient care and team dynamics. 

Scenario 036: A patient comments about a Pride parade to a non-binary staff member 

Scenario 036: A patient comments about a Pride parade to a non-binary staff member 

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Scenario:

You observe a middle-aged man approach the registration desk. He is slightly out of breath. He glances at the staff member, who identifies as non-binary and is wearing a pride pin, and says, “Sorry I’m late—it took ages to get here. All those pride parades really slowed things down.” The staff member shifts their gaze, trying to remain professional, and proceeds with the check-in. 

1) Impact: How might this interaction affect the individuals involved?  Who might it harm? Why? Why does this matter? 

  1. The staff member may feel insulted by this comment from the patient. Especially because pride month is likely a meaningful time for the staff member, they may be disappointed that the parade is simply an obstacle to the patient.  In addition, although we do not know how the patient truly feels about LGBTQ+ individuals, the phrase “all those pride parades” may raise reasonable suspicion that the patient harbors some underlying negative attitudes.   
  2. How all of this impacts the staff member will of course depend on them, how they relate to pride month, how much social support they have, and how they have learned to cope with people who do not seem to understand or agree with the value of pride month. In addition, it may depend on how included, welcomed, and psychologically safe they feel in this work environment.  For some people, such a comment from a patient may contribute to larger feelings of burnout and job dissatisfaction and increase feelings of marginalization, especially if co-workers overhear and do not acknowledge it. To a bystander, it is important to recognize that this may impact the staff member in negative ways and not brush it off as meaningless.     

2) Intervention: If you were to intervene to address the potential harm caused… 

  1. What might you do or say? 
    1. You could say to the patient, “I’m sorry traffic made you late, that is frustrating. However we are very supportive of pride month here.” 
    2. You could say to the patient, “Not a fan of pride month, huh?  We have many staff members for whom it is very meaningful, so please be respectful.”  
    3. You might not be able to say anything to the patient, or in front of the patient. If so, you could wait for the patient to leave and then check in with the staff member.  You could say, “I heard that patient’s comment about the pride parade. Sorry about that.  Would you like me to say something to the patient?” 
    4. If you know of others who may care for the patient at today’s visit who also may be insulted by him, you could give them a heads-up, or if it seems like that could make things worse, you could check-in after. 
    5. It is ok for you to tell your supervisor/manager about the incident, in the service of providing additional support to the person harmed, if they want it. 
  2. What obstacles might get in the way of you intervening? 
    1. You may feel that the interaction happens too quickly for you to figure out what to say or do.  Then it becomes awkward for you to say something. 
    2. You may be unsure what the staff member would want you to do.  Maybe they do not want you to do or say anything? Similarly, you may not want to do or say anything that would make the patient feel bad. In this case, you could still talk to the staff member afterwards, ask what they would have wanted, and offer validation. Also, we recommend that if you in doubt about what the person harmed wants, it is better to take the risk and speak up, rather than not.  
    3. You may wonder if the patient simply was in a bad mood and if their remark really should be interpreted as biased or insulting to LGBTQ+ individuals. In this case, you could still ask the staff member how it impacted them.  If your relationships are appropriate, you could also ask others you know with similar identities for guidance on what the staff member might need in the situation.  

3) Repair: If you are the “offender”, how can you apologize or accept feedback? 

  1. You may say, “I’m sorry, I do think pride month is important; I let my traffic frustration get the best of me.” 
  2. If your relationships are appropriate, you could also ask others you know who have LGBTQ+ identities, for feedback on what you said and why it may have been offensive.  

4) More Information: Additional comments and background information about this scenario: 

  1. Although this may feel like a minor insult, it is important to understand the long and ugly battle for LGBTQ+ rights and recognition. Consider this resource…