The incident

“I was carrying out my internship at a hospital in the city centre of Palermo, where the patient group is very mixed in terms of ethnicity and social status. My internship took place at the department of gynaecology. I was with the main doctor and two other apprentices. A patient was present; a migrant woman.

Before the doctor started the examination of the migrant woman, he invited her to empty her bladder, as usual procedure requires.

While the patient was in the toilet, the doctor smiled ironically at us and put on his gloves, saying  that  they  would  be  needed  to  run  the  check  on  the  woman  in  question.

I realised that the doctor was going to use his gloves only because the patient was an immigrant, and I was upset and dismayed to witness the discrimination that he quite openly displayed. I was upset by the experience that such a “respectable” person as the main doctor would act so poorly.

As a professional, I knew that the gloves are a tool which, especially for gynaecological consultations should always be worn, no matter who the patients are, and where they come from.

I was astonished by his hygienic prejudice about Italian patients being “cleaner” than non-Italian.  I thought to myself that a prejudice such as that shouldn’t even exist and shouldn’t occur, especially in a medical environment. Some tools, like gloves, should always be used.”

1. Identities of the actors in the situation

Persons who were present in the situation:

The narrator is a 25 years old male doctor, newly-graduated practitioner, specialising in gynaecology.  Italian, open-minded, respectful of hygiene norms connected with the medical profession, enthusiastic about the profession.

The Doctor, an Italian experienced man gynaecologist, in his 50s. He has been working for a long time in the hospital, taking care of many women from different ethnic, cultural and social backgrounds.

Other two apprentices, males

The female black migrant patient

2. Context of the situation

The incident took place in a hospital in the city centre of Palermo, where the patient group is very mixed in terms of ethnicity and social status at the department of gynaecology.

The narrator was carrying out an internship at the department of gynaecology alongside two other apprentices with a main doctor. The main doctor was leading the examination and giving instructions to the patient, while the apprentices including the narrator where requested to observe only. The patient had just left the room when the incident occurred.

There would normally be a strong correlation between the actors involved regarding their background and professional context. The medical staff is all from Italy and from the same city. They are doctors and knowledgeable of hygiene practices related to the profession.

The relation between the narrator and the person causing the shock is a professional relation between colleagues, although there is a hierarchical relation between them as well, as one is the older experienced doctor and the narrator is only newly-graduated.

3. Emotional reaction

The narrator was upset and disappointed by the behaviour of the main doctor, from whom he was supposed to learn the practice of the profession.

The narrator was both upset and astonished by the main doctor´s prejudice about Italian patients being “cleaner” than non-Italian patients. The prejudice about the different practices of hygiene for people from different backgrounds made the narrator uneasy. The reason, he then explained, was not necessarily that he does not believe that different cultures may have different hygiene practices, but that the main doctor’s behaviour was discriminatory and in line with stereotypes of migrants and poorer people being dirty.

The narrator was dismayed that such prejudices could still exist. From his perspective, this should not occur anymore, especially not in a medical environment. Some tools, like gloves, should always be used as a set procedure.

4. Representations, values, norms, ideas, prejudice: The frame of references of the person who experienced the shock.

1) Hygienic rules regarding the professional deontology (moral obligation to act abiding a set of rules) and basic ethics

The core values of the medical profession in this case were undermined. The professional narrator who experienced the shock believes that the core set of basic hygiene rules should always be applied in the medical profession. The gloves should be used in all situations with any patient, regardless of the patient’s ethnicity, race, gender, age, linguistic skills, social-economical and socio-cultural background.

2) Equality in the access to healthcare for all citizens

The medical profession provides a service to all human beings related to a delicate and basic aspect of their lives: health. Professionals should treat all patients equally and not adopt any different practices which may – directly or indirectly – exclude and discriminate against individual patients or groups of patients.

Putting aside prejudices concerning the cleanliness of others, the professional should apply the same rules for all.Moreover, from both a personal and human perspective, the narrator is repelled by being a witness to what he considers to be a violation of universal human rules and rights for all patients and citizens – in fact all human beings, who deserve the same respect in any situation.

3) Professionalism

The narrator believes that the main doctor is also taking advantage of his position as gynaecologist to pursue some personal preference or interest in relation to women. This again goes against the narrator´s own ideals regarding the profession as a service to all that cannot be corrupted by the personal identity of the doctor. Also, the main doctor should set an ethical-professional standard and be a professional model for the younger doctors who are approaching the work for the first time. Thus, the narrator finds the behaviour of the main doctor deceiving and a bad model for the younger doctors. The narrator expects the main doctor to fulfil a responsibility of being a role-model towards the apprentices and to behave honourably and professionally towards the patient. to behave honouring the profession also towards the patient.

5. What image emerges from the analysis of point 4 for the other group (neutral slightly negative, very negative, "stigmatized", positive, very positive, real, unreal) etc?

The image that emerges from the analysis:

  • Negative
  • Repulsive
  • Tarnished morality personally and professionally
6. Representations, values, norms, prejudice: The frame of references of the person or group that is causing the shock / that caused the shock in the narrator.

1) Preconception about the cleanliness of “migrant women”

The value that may have caused the behaviour of the main doctor – when he explicitly justifies the use of gloves with the patient’s ethnic-cultural affiliation – may be obtained from a societal fear of “the other”, who in this case could even be perceived as “the other who brings diseases”.

At the professional-ethical level, he should be able to go beyond prejudices and discriminatory behaviour. However, in this incident, he acted from personal beliefs and attitudes, when acting out of socio-cultural and even societal prejudices, regarding women from other cultures to have different hygienic habits and standards than Italian women.

This normative approach may be attributed to specific examples of poor hygiene of previous patients with a “migrant background”. Thus, he may generalise from concrete experience mixed with general prejudices towards migrants and other cultures.

This is also combined with a normative approach to Italian, “native” women, who are generalised as having high hygienic standards, which represent an important value for the main doctor, it appears.

Thus, the incident implies strong cultural values and perception about cleanliness/non-cleanliness, infection free/infection danger, gender, attraction/gender repulsion – as various signs of a cultural hierarchy.

2) Conception of rules and superiority to rules

Even though the main doctor is well aware of the hygienic rules that, in particular, apply for his profession, he believes that he can bend the rules, based on his professional experience, but also based on his formal position as a senior physician.

At the same time, he may have wanted to show the younger doctors that rules do not strictly apply to him because he is more experienced and holds a superior position in the medical hierarchy. Thus, his values may also include a self-consciousness of power, superior rights and privileges – which, in general, is attached to the medical profession.

3) Racism

The doctor has a separate protocol practice for Italian and non-Italian patients which shows a discriminatory behaviour. This double stander enters in conflict with the principle of equality of treatment to all patients. We do not know if this is a conscious behaviour of the doctor but in any case, his practice shows these differences.

7. Does the situation highlight any problem concerning the professional practice, or in general about the respect of cultural differences in intercultural situations?

The person who caused the shock among the interns had acted without evaluating the risks in performing the role of mentor in terms of behavioural guidance. The values of respecting diversity, equal treatment and professional responsibility were highly violated in this incident.

The delicate context of gynaecology, leads to greater sensitivity in terms of gender, sexuality and respect for patients´ diversity as well as patients´ individuality.

Especially in the situation, in which an intern has to learn from a senior doctor, not only the technical aspects of the professional learning, but certainly also the behavioural-ethical aspects of the professional learning – are in play.

In this case, the lack of attention to these behavioural aspects has created a strong discomfort in the intern (the narrator) in terms of his idea of the work of his superior, and because of the need to hide his concern during the medical examination.

The assumption created through this incident has caused a distance concerning the professional practice and the respect of gender, cultural and racial diversity.