“Those people… the problems of this country start with those people. Send ’em all away is what I say! Round ’em up and get ’em outta here!” Her face was scrunched up, cheeks aflame, and she was practically spitting. My patient’s demeanor had transformed from unpleasantly dour to frighteningly enraged in less than ten seconds.

Her ranting continued despite my soft murmurs of “Ooookay. Let’s not get distracted from the purpose of your visit. Let’s stay focused now…”

She had long suffered from mental illness, but when her ranting turned uglier and frankly bigoted, I couldn’t consider her psychiatric diagnosis an excuse. I felt my hackles rising, though I kept my voice low and tried to calm her. She didn’t stop, and she kept railing against “those people”, gesturing wildly in the air, almost rising from her chair.

So I actually slapped my hand down on my desk as I rose my voice:

“Enough! That’s enough. This is no place for that kind of talk. You are here to discuss your health, and that is what we will focus on. Now, let’s get back to the reason for your visit.”

My patient stopped and melted back into the chair, arms folded across her chest, subdued, for the moment.

It doesn’t even matter who “those people” were. Bigotry, racism, intolerance… It’s all the same. It’s anger and hate, plain and simple. “Those people” is just an excuse for spewing pent-up emotion out like nasty vomit. And I wasn’t going to allow that in my office.

It’s harder to know what to say when the spewing is subtle. Sometimes a patient makes an underhanded comment about “those people”, a quiet and unexpected emotional deposit that I  usually end up ignoring or working around, as if they had casually pooped out a smelly little turd in my exam room. The problem is, it fouls up my whole day.

I wonder what other providers do when confronted by bigotry, racism, intolerance, hate… When do people speak up, and what do you say?