I work in a community hospital with culturally diverse patients and staff. Recently, a nurse told me about an upsetting experience. The nurse is African-American and was caring for a patient in a double room. He overheard a conversation between his patient’s roommate and a visitor. In a loud, strident voice, the visitor expressed his views about a situation concerning race that has been widely reported in the media. The visitor criticized the African-Americans involved and made several borderline and blatant racist comments. The nurse heard the comments and left the room without comment, but was angry. He later asked me, “What could I have said?” Several people thought that as a “professional” he acted correctly by not saying anything. I am troubled by the notion that silence is the professional approach to racism. What do you advise?
Usually, I would say that silence is not the professional approach to racism. There is a reason we teach people to have crucial conversations—you can help put an end to evils like racism by sharing your opinion candidly and respectfully. And yet, given the setting and his role, I think your colleague handled himself in the most professional way possible.
I’ll begin with the problems that come from not speaking up. First, when you don’t speak up, you allow the bad behavior to continue. Others see your silence as acquiescence, permission, or even encouragement. We saw this when we studied parents who failed to talk to their children about alcohol and drugs. Their children assumed they had permission to drink and use.
Second, in Crucial Conversations we say, “If you don’t talk it out, you will act it out.” What we mean is that your concerns will be expressed in your behavior—often as bad behavior toward the offending person.
A few years ago, I collaborated on a research study with Dr. Joan Reede, the Dean for Diversity & Community Outreach at Harvard Medical School. We were interested in what happens when people experience an ethnic or sexist slight, but say nothing.
We identified seven categories of common slights, small offenses that most women and minority members experience at least monthly. We called these slights undiscussables because few of the women or minority members spoke up when they experienced them.
We discovered that these undiscussables destroy relationships. Even though the slight was never discussed, 96 percent of our subjects left the interaction believing the other person was a bigot. We called this study Silent Judgment to highlight this dynamic.
So, why do I think your colleague was right to keep his mouth shut despite the obvious injustice he was subjected to? Because he isn’t just a passer-by on the street. In this specific circumstance, as a nurse, he is operating in the patient-caregiver dynamic and that relationship is both unique and sacred.
First, the relationship is lopsidedly unequal. Patients feel powerless, both because they are ill and because they’ve ceded personal control to the hospital and its caregivers. As a caregiver, you awaken them in the middle of the night, you invade their personal space, and you cause them pain. Your patients are at your mercy and only hope to receive it. How bad is it? It’s so bad that most patients and family members won’t even remind a nurse to wash up, for fear of making a bad impression and exposing themselves to retaliation.
Second, because of their illnesses, patients aren’t at their best. I know that when I’m sick, I become grouchy, self-centered, and short-tempered. I hope others will give me a break!
Third, patients are involuntary visitors. They would rather be home, on a cruise ship, at a beach resort, in a ski lodge, or even back at work. They are only in the hospital because their health requires it. They may even feel like prisoners.
Fourth, patients don’t have the privacy they are used to. Instead, they share their rooms and caregivers walk in whenever they want. As a result, comments they intend and expect to be private, aren’t. And it’s not as if they can move to a private location for more sensitive conversations. They’re stuck in their beds.
For these many reasons, I think your colleague was right to stay silent when he overheard the hateful comments. By speaking up, he would likely violate the patient-caregiver boundaries—for both his patient and his patient’s roommate. And though silence may be perceived as tolerance for racism, he should place his patient above his own frustrations while on the job. Should he overhear those comments in a restaurant later that day, I would encourage him and everyone to speak up and put an end to bigotry—but unfortunately, that is not the case in the situation you describe.
And not speaking up also means he will have to deal with his frustration and anger. Remember, “If you don’t talk it out, you’ll act it out.” Acting it out would be unprofessional. It would be what patients fear most.
We’ve all found ourselves in situations where we’ve decided against speaking up and had to master our frustrations. The key in these situations is to step back, take a longer more inclusive view, and get your heart right.
We recommend asking yourself, “What do I really want long term for myself, for others, and for the relationship?” When your friend asks himself this question, it will help him put this incident into a broader perspective. And it will help him act on his values, rather than responding to others’ slights while serving his patients.
I hope this helps,