Addressing Patient Bias and Discrimination Against Clinicians of Diverse Backgrounds

Abstract

The duty to care for all patients is central to the health professions, but what happens when clinicians encounter patients who exhibit biased or discriminatory behaviors? While significant attention has focused on addressing clinician bias toward patients, incidents of patient bias toward clinicians also occur and are difficult to navigate. Clinicians anecdotally describe their experiences with patient bias, prejudice, and discrimination as profoundly painful and degrading. Though this phenomenon has not been rigorously studied, it is not unreasonable to postulate that the moral distress caused by patient bias may ultimately contribute to clinician burnout. Because women and minority clinicians are more likely to be targets of patient bias, this may worsen existing disparities for these groups and increase their risk for burnout. Biased behavior may also affect patient outcomes. Although some degree of ignoring derogatory comments is necessary to maintain professionalism and workflow, clinicians also have the right to a workplace free of mistreatment and abuse. How should clinicians reconcile the expectation to always “put patients first” with their basic right to be treated with dignity and respect? And how can health care organizations develop policies and training to mitigate the effects of these experiences? The authors discuss the ethical dilemmas associated with responding to prejudiced patients and then present a framework for clinicians to use when directly facing or witnessing biased behavior from patients. Finally, they describe strategies to address patient bias at the institutional level.

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

“…Findings may reflect differences in gender or ethnic differences in communication styles, which may affect provider comfort level in screening for use and delivering BIs. In this regard, the potential contributions of systemic racism and implicit bias, also affecting physicians of color (Chandrashekar & Jain, 2020), While the percentage of missing covariate data was within a similar range of other EHR-based studies (Hirschtritt et al, 2019;Lam et al, 2020), unfortunately, reasons for missing data in our study could not be determined. We have no data on important provider factors such as BI outcome expectancies, concerns about intrusiveness, beliefs that SBI is ineffective, negative attitudes about patients with alcohol problems, and self-efficacy; all have been identified as related to delivery of BI (Gargaritano et al, 2020).…”

The impact of racism on emergency health care workers

“…Institutions should consider developing a code of conduct detailing EHCWs' right to fair treatment by coworkers, patients, and patients' family members and a policy that empowers EHCWs to speak up about unacceptable behavior and language without fear of retribution or retaliation. 41 Additionally, consideration should be given to mandatory EHCW education and training about systemic racism and in allyship behavior. 28,[42][43][44] It can be challenging for bystanders and allies to understand when and how to intervene after witnessing episodes of bias or racism, and it is of critical importance that training programs establish guidelines around peer intervention.…”

“…28,[42][43][44] It can be challenging for bystanders and allies to understand when and how to intervene after witnessing episodes of bias or racism, and it is of critical importance that training programs establish guidelines around peer intervention. 41,44 Team meetings and debriefings should be considered as these are "critical" events, and there is demonstrated value in the reflection process and education that comes from these difficult situations. 41 Following witnessed events of bias and racism, bystanders and allies may consider checking in with the individual who was the target of the event, provide an acknowledgement of what happened, and offer empathy and support.…”

“…41,44 Team meetings and debriefings should be considered as these are "critical" events, and there is demonstrated value in the reflection process and education that comes from these difficult situations. 41 Following witnessed events of bias and racism, bystanders and allies may consider checking in with the individual who was the target of the event, provide an acknowledgement of what happened, and offer empathy and support. 41 Bringing the important issues of systemic racism and discrimination to light with open conversation may lead to effective interventions that will improve not only the primary problem, but also the stress associated with systemic racism and inequality.…”

“…41 Following witnessed events of bias and racism, bystanders and allies may consider checking in with the individual who was the target of the event, provide an acknowledgement of what happened, and offer empathy and support. 41 Bringing the important issues of systemic racism and discrimination to light with open conversation may lead to effective interventions that will improve not only the primary problem, but also the stress associated with systemic racism and inequality. 40,42 Black participants reported significantly higher levels of stress due to racism (Figure 2).…”