November 3, 2016

4 ways doctors can handle discrimination from patients

Daily Briefing

    A new study published in Academic Medicine suggests four ways doctors can react when they encounter discrimination on the part of patients or their families.

    An open secret?

    Kimani Paul-Emile, an associate professor at Fordham University School of Law and associate director of the university's Center on Race, Law, and Justice, said it is not uncommon for doctors to face discriminatory acts, such as being rejected by a patient because of their race. "I call it one of medicine's open secrets, because you would be hard-pressed to find a physician, particularly a physician of color, who hasn't had this experience or who doesn't know someone who has," she said.

    For instance, according to a study published last year, nearly a quarter of Muslim physicians in the United States said they had experienced frequent religious discrimination during their careers.

    Emily Whitgob, a fellow in developmental-behavioral pediatrics at Stanford University School of Medicine, became inspired to research how doctors can deal with discrimination after being told of an incident in which a patient requested to see another physician based on the assumption the doctor was Jewish.

    Looking for answers

    For the new study, Whitgob and colleagues interviewed 13 physicians from Stanford's pediatric residency program evaluation committee.  Based on those conversations, the study authors suggested four guidelines for dealing with discrimination:

    1. Assess illness acuity: If a patient is facing a medical emergency, doctors should ignore any discriminatory statements and simply provide treatment, the panel recommended. "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," Whitgob explained.

    2. Cultivate a therapeutic alliance: The panel noted that mistreatment from patients may step from anxieties about their medical situation. Thus, doctors should validate those fears and emphasize the shared goal of providing effective care. "Participants believed identifying, naming, and validating the emotional experience underlying the discriminatory remark was an important step in establishing trust with families," the authors wrote.

    3. Depersonalize the event: Providers should not take discriminatory remarks personally, the study participants suggested. Instead, they said, providers should focus on their professional values and patient care.

    4. Ensure a safe learning environment for medical trainees: Encountering discrimination can be upsetting even for experienced providers, but for trainees in particular, it's important that organizations ensure a safe environment for training, study participants said. In cases when trainees feel discrimination may compromise medical care, they should act quickly to remove themselves from the situation, according to the study authors. "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," the authors wrote.

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    More broadly, the study participants suggested that trainees should be provided with training to deal with discrimination early in their education. Case studies, they noted, can be a valuable tool for developing these skills.

    A starting place

    Whitgob said she hopes the study will prompt more providers to think critically about how to respond to—and prepare for—discrimination. "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.

    Rebecca Parker, president of the American College of Emergency Physicians, said her organization recognized that discrimination against doctors is a serious issue and is working to challenge stereotypes. "We need to also educate our society about the diversification of our physician population," she added (Heredia Rodriguez, Kaiser Health News, 10/27; Howard, CNN, 10/26; Parry, Medscape, 10/26; Stanford University Medical Center release, 10/26). 

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