A patient came to the E.R. where I work, and a nurse gave him a preliminary evaluation. When the patient saw my name, he refused to be examined by a Muslim doctor. I couldn’t reach his primary physician, and the other physician on call was also Muslim. A physician assistant offered to complete the evaluation, but as the patient was in no immediate danger, I did not allow this. Instead I discharged the patient without a full evaluation. Was I right? — Ali Mohamed Osman, M.D., Houston

You were right not to capitulate to religious bigotry, but you might have handled this a little differently. When the patient refused to be seen by a Muslim doctor, you should have told him that your hospital does not assign doctors based on religion — that would be both unethical and illegal — and then reiterated your willingness to examine him. If he remained obdurate, the decision to refuse treatment would have been his, not yours, a choice he has the right to make even if he does so for mutton-headed reasons.

Although the physician assistant was willing to step in, you did well to forbid it. To allow such an accommodation — Can I show you something in a nice Reform Jew? Perhaps something more Presbyterian? — is to abet religious discrimination.

Still, I am uneasy with your discharging this fellow without a full evaluation.

As you no doubt know, there are legal requirements for examining and releasing an E.R. patient. While he may have been in no danger at that time, he could have laid subsequent problems at your door.

To your credit, you showed admirable restraint by not pushing the patient’s gurney down a flight of steps as a less temperate person (me) might have — raising the question of why an intemperate person with no medical training (me) was working in the E.R.


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