October 20, 2017

60 percent of doctors—and 11 percent of patients—say they've experienced prejudice in the medical office

Daily Briefing

    Nearly 60 percent of doctors have heard patients make offensive comments about their personal characteristics or background within the past five years—and few said their employers had appropriate resources in place to help them handle such behavior, according to surveys conducted by Medscape and WedMD in collaboration with STAT News

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    About the surveys

    For the surveys, Medscape and WebMD sought to explore the perspectives and experiences of patients and providers with bias. Medscape's survey included more than 800 practicing providers across the United States and was conducted between July 17 and August 22, while WedMD's survey included more than 900 U.S. individuals and was conducted between July 13 and 17.

    Key findings about physicians' experiences

    According to STAT News, the most common forms of patient bias cited by physicians were related to a doctor's age, gender, race, ethnicity, and weight.

    The Medscape survey found that within the past five years:

    • 83 percent of emergency medicine physicians reported experiencing bias;
    • 62 percent of primary care providers reported experiencing bias; and
    • 59 percent of specialists reported experiencing bias.

    The percentage of physicians who reported experiencing bias was:

    • 70 percent among black physicians;
    • 69 percent among Asian physicians;
    • 63 percent among Hispanic physicians; and
    • 55 percent among white physicians.

    Black physicians were more likely than other physicians to hear race-related comments, while Asian physicians were more likely than other physicians to hear ethnicity-related comments.

    Female physicians were more likely (65 percent) to have experienced some form of bias in the past five years than male physicians (55 percent). Further, male physicians were more likely than female physicians to experience bias related to ethnicity and religion, while female physicians were more likely than male physicians to experience bias related to age, gender, and weight.

    Sixty percent of physicians said they were unsure whether their employer had a formal process for handling patient discrimination. Further, 85 percent either said their institution doesn't provide adequate bias training or that they don't know whether their institution provides such training.

    About one-quarter of physicians—24 percent—have documented a case of bias on a patient's medical record. Ten percent of physicians have reported the bias to a higher-up, and 9 percent have refused to treat a patient who expressed bias toward them.

    Key findings about patients' perspective

    The WebMD survey showed that some patients do avoid certain characteristics in a provider, with 29 percent saying that within the past five years they either had avoided a provider based on personal characteristics or would have avoided a provider if the situation arose.

    WedMD reports that in some cases, apparent bias might stem from a "poorly explained preference." For instance, a female patient might prefer a female doctor for a gynecological exam, or a black patient might ask for a black doctor after having experienced discrimination in the past.

    Further, the survey found bias can go both ways, with 11 percent of patients who had visited a health care provider in the past five years reporting having experienced some form of bias.

    Implications

    For some physicians, the emotional impact of bias can be significant.

    "You come here and pour your blood, sweat, and tears for your patients, and then to have that stuff come up, absolutely it'll lead to burnout," Brian McGillen, director of hospital medicine at Penn State Health Milton S. Hershey Medical Center, said.

    Bias also can have financial implications for physicians, according to Somnath Saha, a professor of medicine and public health and preventive medicine at Portland VA Medical Center and Oregon Health and Science University who's researched patient bias. He explained that bias can influence physician ratings, which are used to determine compensation.

    Separately, Sachin Jain, adjunct professor of medicine at Stanford University, noted that most physicians are unprepared to handle incidents of prejudice, as medical schools typically do not address such encounters.

    A call for action

    Nikhil Patel, a psychiatry resident at Cambridge Health Alliance in Massachusetts, said the medical community needs to devote more attention to the issue. "Our job is to be caretakers, but it's also to care for each other," he said.

    At Penn State Health Milton S. Hershey Medical Center, efforts to address discriminatory patient behaviors are taking root, STAT News reports. Based on an in-house survey on the topic, hospital officials updated the "patients' rights and responsibilities" to reflect that the hospital will not honor patient requests for a new physician based on prejudice (Watson, WedMD, 10/18; Tedeschi, STAT News, 10/18; Cajigal/Scudder, Medscape, 10/18).

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