In July 2013, a man arrived in the emergency room of a California hospital seeking treatment for his child. But when the intern on call walked in to see him, the father looked at her name tag and demanded another physician. As a Palestinian, he didn’t want his child treated by a Jewish doctor. The intern turned to her resident supervisor, Emily Whitgob, who told her colleagues about the incident.
The episode helped motivate Whitgob to study how doctors in training and their institutions should deal with patients’ prejudice and to publish a report that outlines strategies offered by the professionals she and the other authors consulted. The recommendations, published Wednesday in the Association of American Medical Colleges’ journal Academic Medicine, call for trainees to focus on their role as doctors by not taking hostile comments personally and meeting patients’ anxieties with empathy.
Researchers recruited 13 experienced faculty members from the pediatric department at Stanford University School of Medicine in California to review a series of scenarios illustrating patient discrimination against a medical trainee. Participants shared their reactions to the situation and outlined strategies for diffusing the tension in such encounters.
The issue has attracted national attention recently after physician Tamika Cross, a black physician from Houston, posted on social media that a flight attendant had dismissed her offer to help and disputed her credentials when looking for medical aid for a man who needed treatment mid-flight. Her Facebook post went viral, garnering over 48,500 shares as of Wednesday.This KHN story can be republished for free (details).
It’s not clear how often these episodes occur. But the journal article notes that a 2015 survey found that 15 percent of pediatric residents at Stanford had experienced or witnessed mistreatment of medical residents by patients or families. Of those incidents, 67 percent involved discrimination by patients’ families. Half the people in the survey said they did not know how to respond to the discrimination and a quarter thought that the hospital was not likely to take any action against the patients’ families.
The situations can be complicated by the lack of racial and ethnic diversity in many hospitals. According to the most recent data available from the medical colleges association, minorities excluding Asians made up 9 percent of doctors in 2014. In the same year, those same minorities represented 30 percent of the population.
Whitgob, now a developmental behavioral pediatrics fellow at Stanford, said the results of her research can help create a set of guidelines to give hospitals and medical students a framework to handle patient discrimination in the field.
“I wanted to help create the tools so that they can cope with these events in the future,” she said.
The experienced doctors in the study noted that if the patient needs immediate medical attention, providers should ignore any hostile comments and quickly deliver that care.
When the need is not immediate, the study participants also recommend doctors speak honestly to patients about underlying emotional triggers, which may perhaps allow a more constructive dialogue that will get to the patient’s or family’s hostility and may allow both sides to work toward establishing enough trust for care to be given.
Formal training is needed to equip doctors with the skills to engage in these discussions, according to the report. By developing self-awareness and sensitivity, medical personnel can shift the focus away from the discriminatory remarks and emphasize patient care. The group also advised providers to set expectations early in medical training by communicating that discrimination can happen to anyone.
Many of these concepts should not be new to trainees. As part of their accreditation, medical schools already are required to teach students about culturally competent health care.
Rebecca Parker, president-elect of the American College of Emergency Physicians, attended medical schools before cultural competency training was common and said she was initially surprised when patients objected to working with her because of her gender.
Today, Parker has made diversity a priority in her organization with a task force to promote diversity in medicine in part through campaigns that challenge the traditional notions of what a doctor looks like.
“We need to also educate our society about the diversification of our physician population,” Parker said.
Medical training in the classroom alone generally doesn’t fill all the needs, said Dr. Roderick King, associate professor in the department of public health sciences at the University of Miami and CEO of the Florida Institute for Health Innovation. Such training exposes medical students to cultural sensitivity, but that may not provide the necessary skills for developing the right approach for these situations. While he said he understands how the fear of insulting a patient could deter a provider from engaging with a patient from a different background, King views cultural competence as a skill that requires work to perfect.
“The more you practice it,” he said, “the more comfortable you get.”
Whitgob echoes King’s emphasis on real-world training. But a safe learning environment is also important to shield trainees from discrimination, she said. While the experienced doctors admitted facilities can’t protect trainees from every negative situation, peers and supervisors can alleviate the sting by offering their support. The report recommends institutions set up a chain of command for reporting incidents and affirm their commitment to protecting its personnel.
In the emergency room incident three years ago, Whitgob almost confronted the patient on her trainee’s behalf. Ultimately, the intern worked through the situation, but Whitgob says she’s now more aware of the potential for discrimination in the exam room.
“We can’t prevent what comes through the door, “Whitcob said. “But we can think about it on our own time before.”
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