When Patients are Biased
“I want an American doctor”
“Where are the white doctors? I want a white doctor”.
“You seem very nice, honey, but get me a real doctor”
We provide evidence-based tools to organizations, clinicians, and providers to help them provide the unbiased, high-quality care they want for their patients. But what about when the patient is biased and the provider is mistreated? In our organizational climate assessments, we have been fascinated by the wide range of policies and responses—and dismayed by, more often, the lack of policy and response. People who have not directly experienced patient bias do not seem to recognize how deeply painful and degrading, often traumatic, it is. Helpful commentaries and recommendations have been floating around for years, with very little concrete progress in most healthcare organizations. The problem is it permeates health care; abusive comments target Black providers, sexual minority providers, and providers with obesity, with around 40% of Asian and Black providers reporting the highest prevalence.
Conversations about the harm to providers often become conversations about patient rights. 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 (e.g., gender, race, age). 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 to meet the demands of a patient who only wants to be seen by a Lutheran, 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 a patient’s right to refuse treatment from any provider but does not support their right to demand clinically irrelevant provider characteristics. Furthermore, employers have a duty to their employees to ensure their safety and well-being at work and are accountable for taking action to prevent a hostile workplace.
Provide employee support and treat these experiences as the emotionally violent events that they are.
- First, validate and educate everyone in the organization about the nature of the experience. When someone is targeted by patient disrespect, disdain, and hostility, they have experienced an emotionally violent event. The fact that the provider may have developed ways of coping with discrimination due to life-long experiences does not take away from the seriousness of the experience.
- Provide all employees with training on helpful and unhelpful (“dos” and “don’ts”) responses to coworkers who have experienced patient discrimination.
- Promote empathy through role-playing. It may be difficult for many to understand if they have not directly experienced patient bias and discrimination.
- Allow the targeted employee to choose whether to continue working with the biased patient.
- Provide specific sources of support for employees targeted by patients’ and their families’ discriminatory statements and acts.
Develop and disseminate an unambiguous policy.
- Develop and widely distribute a written policy regarding responding 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. Include patient discrimination.
- Provide copies of the non-discrimination policy to all patients upon intake. Ensure it includes information on how the policy is applied/enforced so patients know what to expect.
- Develop materials (in plain language) and specific descriptive language/statements that employees can use when explaining the policy to patients.
This post discusses the most overt forms of patient bias. However, patient bias often takes the form of so-called “microaggressions”*, such as racist or suggestive jokes and comments, questioning the provider’s role, or assuming they are not a provider. We will address this in a future post.
*We feel the term underplays the magnitude of harmful effects, but that’s for another post.