Unconscious man on plane. Wife screaming. Doctor is two rows away. What happens next? Emergency care is delayed because flight attendant doesn’t believe black woman is a doctor.
True story. This medical misadventure aboard Delta this month went viral after a Facebook post by Tamika Cross, the physician turned away from caring for the unresponsive passenger. And she’s not alone.
I’m a physician who investigates human rights violations in medicine, and after Cross’s story was told, I received a flurry of emails from other dark-skinned doctors bypassed in favor of white nurses, pharmacists or doctors. Yes, these female physicians offering critical-care expertise are told to sit down and keep quiet while lesser-skilled, lighter-skinned men are ushered right down the aisle to ailing passengers. Even when women are seated close to ill passengers and identify themselves as physicians, they’re still pushed aside. Here’s why: At 30,000 feet, the pressure of an emergency may intensify underlying implicit bias — a deep-seated, unconscious prejudice that affects our behavior.
So what does a doctor on an airplane look like? Could be the petite new mom in a sundress breast-feeding her infant in the seat next to you or the burly biker dude wearing the backward baseball cap across the aisle. In an emergency, skill trumps everything. A young physician such as Cross is better suited to care for an unresponsive passenger than a retired radiologist. Specialty matters. Ethnicity doesn’t. Hint: Choose a pulmonologist in sweatpants and flip-flops over a well-dressed psychiatrist.
Safety comes first. Let the doctor care for the passenger. Let the crew Google her name via onboard WiFi to verify credentials. Quick reminder: In general, docs don’t carry mini-diplomas in their wallets. Our degrees are framed at the office, not stowed in overhead bins.
Obstructing medical care is never in the best interest of the patient — or the airline. The difference between life and death is sometimes measured in seconds. Not only can one skilled physician aboard an aircraft save a passenger’s life, but her quick action may also save the airline more than $100,000 in a flight diversion and ensure that hundreds of passengers arrive to their destinations on time.
Here are some of the stories I’ve heard from other physicians — in their own words — since Cross went public.
Let’s start with Cross’s experience.
Tamika Cross, chief resident
“I was on Delta Flight 945, and someone two rows in front of me was screaming for help. Her husband was unresponsive. I naturally jumped into doctor mode as no one else was getting up. Unbuckled my seat belt and threw my tray table up, and as I’m about to stand up, flight attendant says, ‘Everyone stay calm, it’s just a night terror, he is all right.’
“I continue to watch the scene closely. A couple minutes later, he is unresponsive again and the flight attendant yells, ‘Call overhead for a physician on board.’ I raise my hand to grab her attention. She says to me, ‘Oh no sweetie, put your hand down, we are looking for actual physicians or nurses or some type of medical personnel; we don’t have time to talk to you.’ I try to inform her that I am a physician, but I’m continually cut off by condescending remarks. Then overhead they page, ‘Any physician on board, please press your button.’ I stare at her as I go to press my button. She says, ‘Oh wow, you’re an actual physician?’ I reply yes. She says, ‘Let me see your credentials. What type of doctor are you? Where do you work? Why were you in Detroit?’ (Please remember, this man is in need of help and she is blocking my row while bombarding me with questions.) I respond, ‘OBGYN, work in Houston, in Detroit for a wedding . . . Now excuse me so I can help the man in need.’
“Another ‘seasoned’ white male approaches the row and says he is a physician as well. She says to me, ‘Thanks for your help but he can help us, and he has his credentials.’ (Mind you he hasn’t shown anything to her. Just showed up and fit the ‘description of a doctor.’) I stay seated. Mind blown. Blood boiling. . . . Supervisor verifies with me afterward that in an emergency they never ask for credentials. This could have been life or death. We didn’t know if he had a pulse!”
(The patient survived and walked off the airplane. In a statement, Delta said it was troubled by any accusation of discrimination and was investigating the incident.)
Kadijah Ray, anesthesiologist
“I’ve received that same treatment on two different flights in 2006 and 2008 while trying to help people in distress. They passed me up for whites: a female pharmacist, nurse and male MD who I believe was something like radiology; I can’t remember exactly his specialty, but I remember him telling them, ‘Trust me, you want an anesthesiologist to help before me.’ And no, I didn’t have my credentials with me. Would far exceed the airline’s weight and size requirements.”
Trupti Shah, emergency medicine
“On an overnight flight from Cairo to JFK in 2007, the lady seated in front of me was having difficulty breathing. I heard the commotion but did not understand the conversation since it was in Arabic. I asked if I could help and identified myself as a doctor. I was told by the male head flight attendant to sit down. Then they made an overhead announcement seeking medical help. I got up again but was ignored.
“A male cardiologist from New York who was fluent in Arabic offered assistance and was immediately ushered to the woman. He noticed that I was trying to help but was not allowed. While they went to get him the medical kit, we spoke. He had trained at my hospital. As soon as he was handed the medical kit, he immediately gave it to me, but the flight attendant tried to take it back. He had to intervene in order for me to help the woman; he translated.
“The woman had taken amoxicillin for a sore throat and developed a rash, itchy throat and shortness of breath. I checked her blood pressure and lungs. Then I administered prednisone, Benadryl and Pepcid from my carry-on (all of which I carry with me when I travel abroad). She felt better after 30 minutes. An hour later, meals were served. I had reserved a vegetarian meal, but when I requested it, the same male flight attendant replied, ‘You people always lie.’ I showed him my printed flight itinerary. He then brought me a completely burned tray.”
Mariam Anwar, internal medicine/geriatrics
“On an international trip during the summer of 2015, the flight manager asked for my credentials and wouldn’t let me help but let a white nurse help without asking for credentials. Of course, I helped anyway. It was an elderly male with emphysema — hypoxic and also having an anxiety attack. We had to calculate if we would have enough oxygen to last the trip without having to land.
“The manager put him in business class and gave us seats, too. We monitored him for several hours. He became unresponsive, hypertensive. I checked an EKG, glucose and after several sternal rubs he woke up. Of course I lost several hours of sleep on a long flight, and a flight attendant had to take care of my toddler while I assisted the man. When his shift was over, another manager came. He told me to go back to economy class, and he let the white nurse stay in business class the entire flight! Blatant discrimination and lack of respect!”
Amina Moghul, family medicine
“Had something similar happen to me in June. A patient fainted right next to my seat. I identified myself as a physician and was pushed out of the way and told to step aside for an older white male RN to tend to the passenger. I was so stunned, I froze for a few seconds before politely introducing myself to the nurse as a physician and recommended we work together.
“The flight attendant continued to ignore me and direct questions and offers to get help or equipment to the male nurse. I thought it was just me who had experienced this.”
Janelle Evans, urogynecology
“On July 22, we were in the middle of the Atlantic on a flight to Johannesburg when a man had a GI bleed and hypotension and became unresponsive in my aisle. Of the four physicians on board, only I had credentials with me, and the purser denied the man care until one of us produced them. An ICU physician was told she could not help. (She was Latina and similarly petite like me.) I told her to ignore the purser and assist.
“While we worked to stabilize the patient, the purser would not put the lights on to start IVs and adequately see the medical kit. The kit was less than half-stocked, with no aspirin, no nitro, nothing. She tried to start drink service while we had a fully naked man in the walkway between lavatories and bloody stool all over one side of the plane. We successfully stabilized him, and no sooner had we done so than she angrily declared that we were relieved of medical duty because she was going to deal with the in-flight-phone physician rather than us. I had made it clear I wasn’t leaving the area and personally spoke with the ground doc, who confirmed that his condition required in-flight assistance. I never received a thank-you from the purser and left the plane with the patient, covered in bloody feces. I never heard from [the airline] until I published my article, at which point they did call and comp our flight.”
Ashley Denmark, family medicine resident
“On [a flight] from Seattle to Hawaii in October, a flight attendant requested over the intercom a doctor or nurse to report to front of cabin to assist a passenger. Without hesitation, I made my way and was greeted by two Caucasian women and a flight attendant. I quickly asked, ‘What’s going on?’ Then I stated: ‘I’m a doctor. How can I help?’ I was greeted by puzzled looks from all three women. The flight attendant asked, ‘Are you a doctor?’ to which I replied ‘Yes.’ The attendant turned around and began to talk to another flight attendant. I stood there in bewilderment.
“Finally, one of the Caucasian women stated that she and the other passenger present to assist were nurses. Then she asked, ‘Are you a doctor?’ to which I responded ‘Yes’ again. She immediately responded, ‘Well, you need credentials to show you are a medical professional.’ I gave her a funny look, remained composed and quickly quipped, ‘I have my hospital badge, which should be enough.’ The attendant continued to look puzzled, then stated: ‘We have two nurses here who came first. You can have a seat now, and we will let them handle it. If we need more help, we will come and find you.’
“Then the gravity of the situation hit me like a ton of bricks. Apparently the nurses and flight attendants didn’t think I was a doctor. Why else were nurses being allowed to take charge in a medical situation when a doctor was present? Surely it couldn’t be the color of my brown skin? So here I was, a doctor with 11 years of training being asked to take a seat and not partake in caring for the passenger in need.
“As an African American female physician, I am too familiar with this scenario. Despite excelling academically and obtaining the title of ‘doctor’ in front of my name, I still get side-eye glances when I introduce myself as Dr. Denmark. Commonly, I’m mistaken for an assistant, janitor, secretary, nurse, student, etc., even when I have my white coat on.”
Wible is a family physician who has provided medical care during two in-flight emergencies. Nobody asked for her credentials.