Editor’s Note: Trisha Pasricha, M.D., is a research fellow in gastroenterology at the Massachusetts General Hospital. She is a physician-filmmaker and director of the recent documentary “A Perfect Match,” about the American residency match process. The opinions expressed in this commentary belong to the author. View more opinions at CNN.
Jacob Blake, the victim of gunshot wounds that left him paralyzed from the waist down, was also shackled to his hospital bed for days. His father pleaded with health care officials and the media to open their eyes to this injustice – or even to common sense. A man who is paralyzed poses no immediate risk that shackling him to the bed could prevent.
This practice is an all too common stain on our profession as physicians. When we care for patients who are handcuffed to their hospital beds, we degrade the vow we make to provide equitable care. The criminal justice system belongs in a court. It has no place in a hospital ward.
When I was a third-year medical student, I learned this lesson the hard way – and not from a patient who was shackled to his bed. I was assigned an elderly patient who was admitted with shoulder pain. To my dismay, his X-rays revealed metastatic lung cancer. He was my first patient ever to whom I had to give “bad news.” I rehearsed what I would say for hours. I had grown so attached to him and wanted to break his diagnosis gently, but honestly.
My senior resident asked me if I knew my patient had been incarcerated most of his life. I hadn’t known that. It was something I had failed to ask about, and he hadn’t mentioned it. She paused and then asked the question. Would I like to know why?
To this day, I regret my answer. Asking patients about a history of incarceration is routine in medicine – it predisposes one to certain disease patterns – but asking what for is not. My colleague had discovered reporting of his crime by local news outlets online. When she told me what she learned, it was more heinous than I had even imagined. I couldn’t reconcile what my colleague said he had done with the person I thought I knew.
I walked into his room to deliver the news of his terminal illness, and botched it completely. I fumbled and avoided eye contact, nervous to be in the same room as he was—a man I had treated compassionately for days. I let that extra knowledge compromise my capacity for empathy as a budding physician. Instead of supporting my patient in his moment of great need, I shunned him. I remain grateful that despite my failure, he taught me one of the most important lessons I learned in medical school. Because of him, I promised myself my patients would never feel they had lost their ally in me again.
Since then, I’ve kept a rule when I am treating patients who have been incarcerated: I never ask why. I teach my residents the same. Whether I recognize it consciously or not, that knowledge introduces bias into my care that should never exist. Allowing those judgments to preside within a hospital not only compromises our empathy, but makes us complicit in greater systems of inequity.
Still, that’s not enough. You can choose to not probe about incarceration, but you can’t ignore a gleaming metal handcuff. Countless times during my residency training, I treated imprisoned patients who were shackled to their beds in ways that defied human decency. One of these patients had an infection of the brain, rendering him unable to recall his own name. I treated another in the ICU as he died from pneumonia. One of the last sensations he felt in this world was the coldness of steel encircling his leg. While law enforcement typically holds the physical key to a patient’s handcuffs (and they or hospital security are usually present to observe incarcerated patients), health care workers can advocate for their removal when being handcuffed hinders a patient’s care. My co-residents and I endlessly argued against handcuffing our patients – some battles we won, most we lost.
Does it surprise anyone that all the patients I just mentioned were Black males? The fact that Jacob Blake was shackled after having been shot in the back seven times by a White police officer tells me that in medicine, as in all of American society, there is too often a Black system and a White system.
This is a moment of reckoning for medicine. We are finally realizing our complicity in a health care system that is disproportionately deadly for Black patients. Think I’m wrong? In my field of gastroenterology, Blacks are approximately twice as likely to die from colorectal cancer than Whites, a disparity that this weekend blazed into the headlines as the disease claimed the life of actor Chadwick Boseman at age 43. We work in a system where Black women are about three to four times as likely to die from pregnancy-related causes than their White counterparts. It’s a system where Black gay and bisexual men in America have the HIV rate of a developing country.
And if none of these statistics sobered you, how about this one? According to a recent study, Black newborns are more likely to die if looked after by a White doctor than a Black doctor. Read that sentence again. The biases we physicians bring to patient care contribute to the health crises that hold Blacks hostage to suffering – and the cost can be our patients’ lives.
Let’s do better. The next time you are giving care in a hospital and you see a patient handcuffed, ask yourself (and the law or security officers present): Does this patient represent an immediate threat to themselves or others? If the answer is no, then stop enabling the oppression. Speak up. Advocate for the cuffs to come off.
I know many will fear that removing prisoners’ handcuffs could place hospital personnel at risk. In the US, where Blacks have a sixfold higher rate of imprisonment than Whites, around 40% of the nationwide prison population do not pose an obvious public safety risk, according to research from the Brennan Center for Justice. Many are in jail awaiting trial because they cannot afford bail. There is also a distinction between someone who is “under arrest,” but not yet been convicted (like Jacob Blake) and those who are actually incarcerated. Many of those prisoners have already demonstrated years of “good behavior.” These are factors that should go into the shared decision between health care providers and law enforcement of removing someone’s handcuffs when they cross the threshold of our care. For as many as we can, let’s then divest some of the resources we spend on multiple 24/7 guards into psychologists and social workers, or into paying bail for prisoners trapped in Covid-19 breeding grounds.
None of this will be easy. Rectifying the discrimination and flaws in our health care system will take training, self-reckoning and years of undoing the damage we already caused. But we can start with something concrete and immediately effective.
Unshackle our patients. Literally.