How the politics of Trump test the Hippocratic oath

It’s 7:37 a.m. on a Thursday at the hospital where I work in the Boston metropolitan area.

My first patient is a woman I'll call Ms. Jones. She’s 85 years old, with a history of congestive heart failure and smoking, Type 2 diabetes, and severe chronic obstructive pulmonary disease. She was admitted to my service after complaining of shortness of breath for four days at home.

“Hello, my name is Dr. Chi Huang, and I am the physician caring for you. What are you watching on TV?”  

As I sit, to be at eye level with Ms. Jones, she turns toward me and squints through her thick bottle-cap glasses. She looks behind me and surveys my team with fixated intent.

“Hello doctor, I am watching the news. You know what I think. I think that we should get rid of all those 'ragheads' just like [Donald] Trump says.”

Did she really just say that? Suddenly I’m back in high school in Texas.

“Hey 'egg roll,'” the jocks would yell across the cafeteria. “Your kind is supposed to be smart. How about doing my homework for me?”

They called me “chink,” too — that was the worst.

How do you respond to a comment like this? Over the years, numerous times, I've played out in my head what I might say. But each time it actually happens, I am stunned and speechless.

It’s no different this time. My mind swirls back and forth. What do I do, as a physician? As a father of four kids of different ethnicities? As a person of faith? As a person who is not of the majority race?

It takes time, but eventually I offer a response.

“Ms. Jones, I am puzzled by your statement. Only the Native Americans were here before the pilgrims. The rest of us immigrated here. In fact, my parents came here from Taiwan during the 1960s. I was fortunate enough to become a physician. Now, I’m able to take care of your breathing problems.”

The woman glances at me again for several seconds and then stares at my team: a Southeast Asian-American medical student who grew up in Ohio; a Caucasian-American medical student who grew up in Massachusetts; two internal medicine interns originally from India; and a Southeast Asian-American resident physician from Indiana.

An uncomfortable silence follows.

I examine Ms. Jones, discuss the physical exam findings, and communicate the day's plan for treating her COPD.

I ask her if there is anything else we can do better for her.

“No, and thank you for caring for me,” she says.

Later, I call the team into my office. I tell them that today, we are not going to discuss evidence-based medicine but rather what happened this morning with Ms. Jones.

There is rustling of papers. One intern is bouncing his left leg up and down; another will not look up from his notes.

“This office is a safe place for us to discuss what she said. So, what went through your mind when she made that Trump comment?”

Silence. I try again.

“Well, I can tell you that I was offended. How about you, Mohammed, as the senior resident? What went through your mind?”

Mohammed looks down at his feet and then looks up.

"Ummm. I was offended. I really was."

The floodgates open.

“I don't know if she really knew who she was speaking to,” says a medical student. “Did she not know that most of us are not Caucasian? Maybe she couldn’t really see us with her poor vision.”

"Dr. Huang, it happens to me often,” says the resident physician. “One of my patients in the outpatient clinic told me, 'I hate Indians.' He told me he didn’t want to be treated by my kind.”

"I’m sort of used it. It happened to me growing up in a small town in the Midwest all the time,” adds the medical student.

“I was confused,” says the intern. “Did she think that I was of Arab descent? I am from India.”

“I am glad that you said something,” she tells me.

That morning with Ms. Jones took place almost a year ago now, on Dec. 11, 2015. Since then, the political discourse in the United States has moved from heated to violent and ugly.

Racism has long been a subtle and not-so-subtle feature of my life as a minority in the United States. But I see every day now how Trump has made it OK not just to think racist ideas, but to say them. A paper published this week in the journal Academic Medicine found that, last year, about 15 percent of pediatric residents at Stanford University's Lucile Packard Children's Hospital personally experienced prejudice by patients or their families.

We each make choices every day that can affect this. We make choices regarding whom to include, and more importantly, whom to exclude. In the workplace, at the local coffee shop or at the ballot box, we make choices. If Trump wins in November, it will not be because of his actions. It will be because of our inaction.

Thirty years ago, I stood together with my fellow first-year students on the grassy fields of my medical school. I held up my right hand and repeated the Hippocratic oath. I did not fully understand or even appreciate the phrase "primum non nocere" — “first do no harm” — until I became an attending physician.

Doing no harm means waking up at 5:30 in the morning and driving to the hospital to have end-of-life discussions with a patient and their family.

Doing no harm means not facilitating an opiate-addicted patient's behavior with more morphine — even though it may be the easier option.

Doing no harm means triple-checking your house staff's medication orders.

In the case of Ms. Jones, doing no harm meant caring for her with respect and professionalism. It also meant speaking up — and on behalf of my medical students, interns and my residents — against hate.

Dr. Chi Huang is a physician leader at a Boston metropolitan area hospital and has received numerous teaching awards from medical schools and residency programs. He has been an inpatient academic teaching attending as a hospitalist for nearly 15 years.