Doctors dealing with patient bias and prejudice

When Patients are Biased

The apparent conflict between patient rights and non-discriminatory policies is complex. However, organizations create an ethical and practical slippery slope when they meet patient demands for providers with specific (clinically irrelevant) characteristics. If a request for a provider with a specific skin tone is honored, must patient requests for a provider with a specific hair color also be honored? Is the organization equally willing meet the demands of a patient who only wants to be seen by a Lutheran or Scientologist or Jewish provider? What happens when a patient does not want to be seen by providers of a specific astrological sign?

Case law supports patients’ right to refuse treatment from any provider, but does not support patients’ right to demand clinically irrelevant provider characteristics. Recent cases have gone badly for health care organizations that meet patient demands in a way that results in unequal working conditions for employees.

Our Suggestions

  • Develop and widely distribute a written policy regarding response to patient requests for health professionals with clinically irrelevant characteristics such as a specific race, ethnicity, and/or gender.*
  • Develop clear and specific procedural policies. For example, who must be notified of such a request? Who is responsible for informing the patient of the policy? What kind of documentation will you require?
  • Prominently post non-discrimination policies
  • Provide copies of the non-discrimination policy to all patients upon intake.
  • Provide a written handout stating the policy to be given to patients who make such demands. Include the statement that meeting gender, religion or race-based demands would undermine the quality of care they
  • receive because it disrupts the practice’s carefully designed procedures (designed to maximize positive outcomes) and workflow.
  • Consider developing a separate policy regarding patients’ documented religious beliefs and practices that result in preference for specific provider characteristics
  • Employee training
  • Develop materials (in plain language) and specific descriptive language/statements employees can use when explaining the policy to patients.
  • Train employees on how to deal with insistent patients (calm and friendly, unwavering, “staying on message”, specific language).
  • Acknowledge the stressful nature of such demands and provide emotional-regulation training.
  • Use role-play and rehearsal.
  • NOTE: Training on this topic can build on or mirror existing training on working with challenging patients and situations.

Employee support

  • Allow your employees to make their own choices about whether they agree to be assigned a racist/sexist (etc) patient.
  • Ensure acceptance and support for either choice.
  • Provide specific sources of support for employees targeted by patients’ and patients’ family discriminatory statements and acts.•
  • Provide all employees with training on helpful and unhelpful (“dos” and “don’ts”) responses to coworkers who have experienced by patient discrimination.•
  • Consider structuring opportunities for all employees to gain empathy by imagining themselves in the shoes of an employee who has been targeted by patient discrimination.