“This happens all the time”: a Qualitative Study of General Internists’ Experiences with Discriminatory Patients

Abstract

Background Workplace discrimination negatively affects physicians of color personally and professionally. Although the occurrence of discrimination from patients has been visible in social media, popular press, and personal essays, scant research exists on patients as a source of discrimination directed at physicians of color. Objective To explore practicing general internists’ experiences observing or interacting with patients exhibiting discriminatory behavior directed at physicians of color. Design A qualitative study with in-depth, semi-structured, one-on-one telephone interviews conducted and recorded between May and September 2019. Participants A purposive sample of 24 general internists practicing at 12 academic health centers in the USA: 14 self-identified as White and 10 as a physician of color, which included Asian, Black, Native American, and self-identified other race. Approach Four coders analyzed the transcribed and verified interview text; thematic analysis was used to inductively identify cohesive themes and subthemes. Key Results Analyses revealed four major themes: (1) assumption that a legitimate doctor is White, male, and able-bodied; (2) legacy of the Black experience; (3) working through the struggle of discrimination; and (4) ethical dilemma of providing care to discriminatory patients. In addition to discrimination from patients based on a physician’s race or ethnicity, participants described experiencing or observing discrimination based on a physician’s gender and disability status. Participants generally expressed a need for greater support from colleagues and more guidance from institutional policies. Conclusions General internists practicing in academic settings reported observing or experiencing discrimination from patients based on the physician’s race, ethnicity, gender (or their intersection), and disability status and the ethical dilemma of providing care to such patients. These results contribute to growing evidence of the need for institutions to better support an increasingly diverse physician workforce with policies and specific guidance to help physicians respond to discrimination from patients while still providing quality care. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06696-7.

Asian Healthcare Workers and Their Experiences of Racism in North America: A Scoping Review

“…Of the included articles, the year of publication ranged from 1999 to 2021. Only one (7%) article was published prior to 2000 (Corbie-Smith et al, 1999), with seven (47%) articles published between 2001 to 2020 (Andal, 2006;George, 2001;Leung, 2008;Murti, 2010;Nunez-Smith et al, 2009a;Nunez-Smith et al, 2009b;Xu et al, 2008) and seven (47%) articles published between 2011 to 2021 (Bakken et al, 2021;Bhatt, 2013;Filut et al, 2021;Fujiwara, 2012;Hennein et al, 2021Hennein et al, , 2022Shang et al, 2021). See Table 1 for year of publication breakdown and study methodology.…”

“…Geographic Location. The majority (n = 13, 87%) of the included articles were focused solely on Asian healthcare workers within the United States of America (Andal, 2006;Bakken et al, 2021;Bhatt, 2013;Corbie-Smith et al, 1999;Filut et al, 2021;Fujiwara, 2012;George, 2001;Hennein et al, 2021Hennein et al, , 2022Murti, 2010;Nunez-Smith et al, 2009a;Nunez-Smith et al, 2009b;Xu et al, 2008), while only one article (7%) focused solely on a Canadian population (Leung, 2008). One (7%) article included a sample from both the United States of America and Canada (Shang et al, 2021).…”

Physician Men Leaders in Emergency Medicine Bearing Witness to Gender-Based Discrimination

“…[8][9][10] Research suggests that cultures that promote inclusivity and support upstanders (ie, persons who intervene on behalf of others) are needed to end GBD. 11 Multiple studies describe the experiences of women physicians who experience GBD 8,[12][13][14] ; however, little is known about the experiences of men physicians who witness, learn of, or perpetrate GBD toward women. The objective of this study is to describe the selfreported responses of men who are academic department chairs in EM to GBD directed toward a woman colleague.…”

Muslim American physicians' experiences with, and views on, religious discrimination and accommodation in academic medicine

“…5 Physicians from minority backgrounds tend to confront biases from their leaders, colleagues, and patients more so than White physicians. 5,7,16,17 The negative impacts of workplace discrimination on physicians' well-being are widely documented. 4,18,19 These include decreased job satisfaction, increased job turnover, and higher stress levels, all of which adversely impact patient care.…”

“…These experiences include patients questioning their competence or refusing their care, to invidious scrutiny by colleagues and supervisors, 11–14 and encountering manifold microaggressions 15 including racist and demeaning comments 5 . Physicians from minority backgrounds tend to confront biases from their leaders, colleagues, and patients more so than White physicians 5,7,16,17 …”