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Cultural safety


Respect for patients and families

Requests based on cultural or religious grounds


Female patient speaking with male doctor

In Canadian healthcare, it is deemed appropriate in most situations for a male physician to care for a female patient. Nevertheless, in some cultures this is deemed inappropriate and perhaps forbidden.

  • While there is no requirement for absolute accommodation of gender-based requests to change physicians, it is both culturally sensitive and prudent to make reasonable efforts to address patient requests to be treated by another physician. The discussion with the patient about this issue is preferably done at the outset of the interaction so that there is sufficient time to make alternative arrangements. Consulting available policies of the institution may also be helpful.

Female patient speaking with female doctor

If urgent or emergent care is required and a physician of the requested gender is not available:

  • Discuss with the patient the nature of call schedules and the fact that a physician of the requested gender is unavailable.

Some patients may refuse all proposed accommodations or alternative arrangements and simply choose to be discharged against medical advice. In such circumstances:

  • Outline the risks involved in refusing care.
  • Suggest that the patient seek care elsewhere.
  • Offer to continue to treat the patient until alternative care becomes available.
  • Document the discussion in the patient's medical record.
  • You may, after discussing the risks of discharge, consider asking the patient to sign a written acknowledgement that they have been advised of the risks of discharge and are refusing further medical care.

Case: Patient refuses to see the physician
Close up of pregnant woman's belly

Background

A 28-year-old pregnant woman presents to the female physician that she expects will deliver her baby.

The physician explains the policy for physician coverage of the labour and delivery unit which advises patients that they must be evaluated and treated by the physician who is on call, regardless of gender, race, and so on.

The patient becomes very upset, as she believed this physician would be delivering her child. Due to her religious beliefs she will not agree to a male physician under any circumstances.

Think about it

  • What should the physician do next?
  • Is the hospital policy appropriate?
  • What are the potential risks for the physicians?
  • What are the options for the patient?
  • What if the patient requires urgent care at any point in her pregnancy?

Lessons learned

When such situations arise, physicians may be placed in a difficult ethical and legal position, particularly when the patient requires urgent care and there is a shortage of other available physicians.

While physicians following policies like the one in this case may not intend to discriminate against the patient, there is a risk that this may be perceived as a form of discrimination.  

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