“Dom, I had to call a rapid on your lady overnight.”
I shook my head as I settled in at my workstation, pushing back the irritation rising in my chest. I had spent the last two days going back and forth with Ms. J about how to get her atrial fibrillation with rapid ventricular response under control. She had adamantly refused metoprolol and amiodarone, citing how terrible and nonfunctional they made her feel. At home, she had been cutting her amiodarone in half before stopping it altogether one month ago. She was an active woman who spent her retirement volunteering in service to others. Her independence was non-negotiable, and she refused anything that made her feel like a shell of herself.
I value patient-centered care, but as her heart rate climbed and she refused every intervention, I began to question how much autonomy patients should be afforded in life-threatening situations. My team saw her as difficult. A part of me agreed.
This rapid response felt like an “I told you so” moment. I reviewed Ms. J’s telemetry and headed to her room. She heard me coming and was halfway out of bed when I walked in.
“I told them I’m gonna get that little black heffa in the morning.”
She was serious, but I could also hear the relief in her voice. I had grown used to that kind of colloquial reception from my older Black patients. Our cultural familiarity fosters connection, but it also carries an unspoken pressure to get things right. I exist within a system not built for many of the patients it now serves, yet I am seen as its representative. I’m the one that patients confide in, and I’m the one expected to explain and defend decisions shaped by a system they’ve learned to approach cautiously. I feel like a bridge between two worlds that are only somewhat familiar with each other and whose history is tainted with distrust.
“Ms. J, you had them scared last night. What happened?”
“That night doctor bout scared ME to death!” She described the panic of people rushing in, adjusting monitors, and whispering among themselves—never asking how she felt, never making her feel seen.
After that night, something shifted. Ms. J remained firm in her convictions. She still refused beta blockers but was more willing to talk through her reasoning. I stopped trying to win the argument and started listening. She was not reckless. She was tired. Tired of being told what to do. Tired of feeling like her life belonged to doctors and not herself. “They act like I’m stupid,” she told me, eyes narrowed. “But I’ve been in this body longer than any of y’all been practicing.”
This wasn’t just a medical disagreement. It was a generational and cultural standoff wrapped in the urgency of a life-threatening situation. My training told me to guide her toward evidence-based therapy, but my gut and lived experience led me to pause and meet her where she was. Ms. J taught me that what we call professionalism doesn’t always feel like care to the person receiving it. I was being molded by a system that prizes composure, neutrality, and respect for hierarchy. She had spent years on the other side of that performance, learning to associate it with dismissal and coldness. Our understanding of professionalism came from different worlds, but our connection allowed us to create a shared one.
After many conversations, we agreed on electrical cardioversion. It worked. Both her rhythm and our trust were restored. There were still difficult decisions ahead, but we had fought and won the immediate battle together. This felt like a major victory.
This is what professionalism should look like: compassionate negotiation, not cold authority. True partnership, not paternalism. Our patients are advocates and survivors, not passive recipients of care. They bring lived experience to the table. Their trust must be earned and reestablished. Trust is not built through force or fear. Today’s medical professionalism means listening through discomfort, honoring agency, and seeing patients as whole people.
When we rid ourselves of rigid, outdated models of health care and choose to meet patients and colleagues with curiosity, humility, and authenticity, we can begin to heal some of the harm caused by our medical establishments and build something more genuine in its place. A reimagined professionalism is about showing up fully human, accountable, and open to learning alongside those we serve.
Dominique Mosley, MD, is a first-year internal medicine resident at Emory University with a passion for patient empowerment and culturally responsive care. She is particularly interested in women’s health, hematology/onco