You Shouldn’t Need to Show Your Papers to Get Medical Care

(The Washington Post) - As I was deciding whether to intubate my new patient — a 23-year-old man, ravaged by cancer, clearly struggling to breathe — his mother handed me two envelopes.

In broken English, she urged me to open them. In the first was a copy of his medical records: prior treatments, scans and labs. In the second was his certificate of American citizenship.

Later, when her son had a tube down his throat and an IV in his neck, I asked her why she’d brought the citizenship document.

“I don’t know,” she said, avoiding eye contact, her voice breaking. “I thought maybe … “

With the help of an Arabic interpreter, she told me that after driving halfway to the hospital, she’d returned to the family’s home to get the certificate — fearing that without it her son might not be treated or would be turned over to some authority.

As a doctor, I’ve grown accustomed to things I never thought I would. Not infrequently, my scrubs are splattered with vomit or blood. There are days when half a dozen patients die and I’m left wondering if I’ve given them some small measure of comfort or peace in their final moments.

But today, if I hope for anything, it’s that I never grow accustomed to mothers feeling compelled to bring me papers proving their dying children are worth treating. I pray that man-made cruelty doesn’t add to the inevitable suffering caused by the laws of nature.

I worry that new immigration policies — such as President Trump’s recent executive order — are adding to that suffering. There’s been much talk about the number of people affected and whether the entry ban will survive legal challenges. But the deeper, longer-lasting consequence of harsh immigration policy and rhetoric is a destruction of the bonds that tie us together as doctors, patients and communities. And that will be true regardless of the ultimate fate of the ban.

American medicine has a complicated history regarding care for vulnerable and marginalized populations. The past two decades have seen improvements in reducing racial health disparities, expanding access to care and growing more culturally sensitive toward those of different backgrounds.

At the same time, many racial and ethnic minorities feel uncomfortable seeking medical attention and face significant language barriers. Too many patients avoid disclosing their gender orientation to health providers — many of whom may not ask — for fear of stigma, and can experience worse health outcomes as a result. And many immigrants simply don’t seek care — fearing mistreatment, costs or deportation.

We in the medical community have struggled with these issues. But the current political climate exacerbates these problems and crystallizes the need to more urgently examine and address the subtle and not-so-subtle ways people feel marginalized within the medical system. That’s true not just for patients, but for doctors, too.

Nearly a quarter of U.S. physicians were trained abroad — and these doctors play a critical role in our health system. (And almost 25 percent of health-care workers are foreign-born.) Foreign-trained doctors are more likely to practice in lower-paying specialties with physician shortages, like psychiatry, pediatrics and primary care. They’re also more likely work in rural and underserved areas. They provide care that’s just as good as domestically trained doctors.

But these physicians often face substantial training and licensing hurdles before being allowed to practice in the United States and sometimes additional discrimination within the hospitals and communities in which they serve. More-restrictive immigration policies will make things worse.

More than 8,000 physicians hail from countries banned by the recent executive order — and thousands more come from other Muslim-majority countries. There are already reports of doctors being detained and deported. The issue is not just one of the scale of deportations, but also one of their social impact — the tearing of the societal fabric each time we declare that this doctor, or that patient, doesn’t belong.

I worry that our contentious politics will trump our shared humanity, making it harder for patients to receive — and harder for doctors to provide — good medical care. Does a heavily accented doctor avoid speaking up in a conference? And what happens if the mother of another dying son, in her fear and panic, forgets her immigration paperwork?

The more turbulent the times, the greater the clarity with which we must speak and the resolve with which we must act. It’s our duty to ensure that patients of all backgrounds feel welcome in our hospitals — and that doctors of all backgrounds feel comfortable caring for them.


Khullar is a resident physician at Massachusetts General Hospital and Harvard Medical School.