Is There a Right Way to Handle Discrimination from Patients?

Discrimination is defined as biased or prejudicial treatment of an individual or a group of individuals based on traits such as gender, age, sexual orientation, race, or religion. It derives from the Latin word discerno, which means I separate or I distinguish. Discrimination is commonly brought about by a few distinctions such as misunderstanding or fear of the unknown. While children at a young age quickly learn the difference between genders, cultural values and beliefs are learned through different perspectives – through family, friends, peers, and observations of the world around us. This is why discrimination is rather complicated to explain – due to each individual’s own perception of the term. Today, racism and discrimination are embedded into social, economic, and political aspects of society. The differences in such aspects can be seen through income, food, education, housing, and even healthcare.

All doctors take an oath to treat patients respectfully and as equals, regardless of their gender, age, sexual orientation, race, and religion. Unfortunately, this is not always the case for patients’ treatment of doctors. Research shows that the discrimination of doctors due to race or sexual orientation is far more common. In fact, over 60% of medical trainees have reported to being harassed, mistreated, or discriminated in some way. When a patient refuses care, it can raise legal, ethical, and clinical issues. However, it can also be baffling and hurtful for the doctor(s) involved. Researchers fear that as the U.S. doctor population is becoming more culturally diverse, more biased demands will only increase. Therefore, researchers have reached a point where they are looking into how doctors can deal with such situations in an effort to consider and address patient demands.

A recent study, conducted by researchers from Stanford University School of Medicine, was published in the journal Academic Medicine. The study involved interviews among 13 pediatric physicians based on their own experiences with gender, religious, and racial discrimination. The researchers decided to interview this group of 13 physicians because they were also responsible for guiding medical trainees and if a young trainee were to experience discrimination in the clinical setting, there is a good chance that one of the participants would hear about it. During the interviews, the participants were given a few different clinical scenarios involving family discrimination. They were asked what advice / recommendations they would give to trainees about how to respond effectively in such instances, as well as how they would address such scenarios themselves as supervising physicians. “We can’t prevent it, but we have to be prepared for it. That’s the big goal: Start talking about it and let trainees know this will very likely happen. Here’s who you talk to when it happens. Please don’t keep it to yourself” said Dr. Emily Whitgob, a doctor of developmental behavioral pediatrics and lead author of the study. When asked what inspired Dr. Whitgob to conduct the study – “I was inspired by an event of discrimination when I was a supervising resident, and my intern presented a case to me. After giving me the details of the child’s injury she told me that the parent pointed to her name tag and asked Is that a Jewish last name? I don’t want a Jewish doctor; I’m from Palestine. I realized that I wasn’t fully equipped to help the first-year doctor deal with this event, nor was our faculty attending. When I presented the case to a morning meeting of my co-residents, several of the people in the room were in tears as they discussed discrimination they had faced throughout their education. They were upset to think that physicians face discrimination at this point in time” she said.

Based on the results gathered, four main themes for dealing with discrimination emerged:

• Evaluating the medical needs of the patient – Participants agreed that it is necessary to avoid responding to any discriminatory remarks made and to continue providing care in emergency cases. “If this is a child who has a gunshot wound and is bleeding out, then none of the other approaches are appropriate because first you have to save this child” said Dr. Whitgob.
• Creating a therapeutic relationship – Participants agreed that when faced with discriminatory behavior in non-emergency settings, it is necessary to draw in attention by emphasizing shared health-related goals. “Participants believed identifying, naming, and validating the emotional experience underlying the discriminatory remark was an important step in establishing trust with families” stated the authors.
• Depersonalizing the situation – Participants suggested that discriminatory remarks made should not be taken personally but rather the goal should be to focus on minimizing negative comments that could interfere with patient care and to continue providing necessary care based on quality and safety.
• Creating a safe learning environment for medical trainees – Participants agreed that harmful discriminatory remarks should be dismissed and the goal should be to remain focused on professional principles and medical care. “We recommend discussion of this type of mistreatment early in training, so trainees feel equipped to respond and feel permission to remove themselves from care when necessary” wrote the authors.

“Institutions also have a role to play in equipping providers with ways to deal with discrimination from patients and their families. They should open the discussion about discrimination at the beginning of all training stages, including medical school, clerkships, and intern years. Faculty and staff should be provided with training to better equip them to advise those they are educating. There should be an institutional response for all levels of providers that makes it very clear that the institution does not tolerate discrimination of any type. Along with individual providers, the institution is responsible for creating a safe learning environment” said Dr. Whitgob.

To conclude, Dr. Whitgob and fellow researchers highlighted the need to create institutional guidelines for the purpose of addressing patient discriminatory issues against doctors. “Processes must be in place to ensure protection of trainees and the faculty who train them, and to ensure continuity of care for patients needing transfer when they refuse to be treated by the team” stated the authors. Dr. Whitgob hopes that the study will be able to raise doctor awareness of how to prepare for and effectively respond to discriminatory behavior. “It's going to be shocking when someone says something horrendous, but previous training may help to have some kind of action plan in the back of your mind that you can employ” she said.

Once in a while, you may get a patient that is outwardly discriminatory toward your sex, race, or anything else they notice. When a patient rejects you as a medical professional based on your race or cultural background, there is little that can be done by hospitals and doctors in regards to effectively balancing their preferences, needs, and interests, as well as your rights and duty to treatment. In some situations, it can be hard to separate your feelings from the realities and limitations of the legal system and while it is impossible to be fully prepared to prevent discriminatory behavior of patients, you can be more aware of how to react in such situations. You can learn to recognize and understand such attitudes / actions and be open to controlling bias behavior.

Unfortunately, discrimination and racism will never be fully eliminated on a global level or even in healthcare for that matter. However, you can start by helping your staff members and medical trainees learn to respond to discriminatory remarks. At the very least, you can learn from them as a part of your medical education and in turn, educate others. Doing so, you can help to create clinical learning environments that are safe, supportive, tolerant, and exude respect. As the great Martin Luther King, Jr. said – “People fail to get along because they fear each other; they fear each other because they don’t know each other; they don’t know each other because they have not communicated with each other.”