How doctors can respond to discrimination from their patients

“We don’t want a diversity quota doctor.”

When one of Emily Whitgob’s interns was subjected to anti-Semitic comments from the parents of a child she was treating, the Stanford researcher brought the incident up at a meeting. She learned that many residents in the room had also faced discrimination by patients on the basis of gender, religion, race, and a host of other factors. The experience led her to explore ways to prepare doctors in training to handle such incidents. We asked her about her about her findings.

ResearchGate: What inspired you to conduct this study?

Emily Whitgob: I was inspired by an event of discrimination when I was a supervising resident, and my intern presented a case to me. After giving me the details of the child’s injury she told me that the parent pointed to her name tag and asked, “Is that a Jewish last name? I don’t want a Jewish doctor; I’m from Palestine.” I realized that I wasn’t fully equipped to help the first-year doctor deal with this event, nor was our faculty attending.

When I presented the case to a morning meeting of my co-residents, several of the people in the room were in tears as they discussed discrimination they had faced throughout their education. They were upset to think that physicians face discrimination at this point in time.

RG: How widespread is the problem of discrimination against doctors by patients and their families?

Whitgob: While we did not gather this information in our study, we know from a separate study that 40 percent of disruptive behavior that first-year residents experienced came from patients.

RG: What are some other examples of discrimination physicians face from patients?

Whitgob: The three scenarios we used in our study were based on real events in pediatric care settings. The first scenario involved an African American junior resident whose path to an infant patient was blocked by the child’s mother. The mother made racist comments and stated she did not want her child treated by a “diversity quota doctor,” demanding another physician “who is actually smart” enough to treat her daughter’s illness. In the second scenario, the mother of a teenage girl in an OB/GYN clinic takes a male medical student aside and says she doesn’t want a man examining her daughter. The third scenario depicts religious discrimination and is similar to the interaction my intern experienced.

RG: Whom did you interview for your study, and why did you pick these individuals as subjects?

Whitgob: We interviewed pediatric faculty leaders at Stanford who have clinical, research, and teaching responsibilities. They were purposefully selected from the pediatric residency Program Evaluation Committee, because they would be able to discuss both their own experiences and how they would react if their medical students and residents were discriminated against.

RG: What were some of the most important considerations you found should dictate doctors’ responses to discriminatory behavior by patients?

Whitgob: Based on our results, there are a few things a physician can do personally. First, it’s important to focus on patient care, and ensure that remains the priority. Physicians should also think in advance about the boundaries of what they are willing to tolerate. From there, they should aim to cultivate a therapeutic alliance with patients and their families, asking about their concerns and emphasizing the importance of the patient’s health above all else. And finally, physicians should try to protect learners and staff from patients’ prejudice.

Institutions also have a role to play in equipping providers with ways to deal with discrimination from patients and their families. They should open the discussion about discrimination at the beginning of all training stages, including medical school, clerkships, and intern years. Faculty and staff should be provided with training to better equip them to advise those they are educating. There should be an institutional response for all levels of providers that makes it very clear that the institution does not tolerate discrimination of any type. Along with individual providers, the institution is responsible for creating a safe learning environment.

RG: Your study focuses on race, gender, and religion. Are there other kinds of discrimination do you know to be common?

Whitgob: Age, most definitely. Younger doctors can be considered inexperienced, and older doctors can be considered out of date with current research. There is also discrimination based on immigrant status and foreign accent, sexual orientation, and other factors.

RG: What has the response to the study been like?

Whitgob: The response has been overwhelmingly positive. I don’t think people have thought about discrimination in this direction as much as discrimination toward providers coming from within the institution. There is certainly much more written about that type of discrimination. Fostering the conversation is one of the main objectives of this study, and it is also a satisfying reward. Interview subjects seemed pleased to engage in their interviews, and workshop participants had the opportunity to process discriminatory events they had experienced years prior and had not discussed.

RG: How applicable are your results from pediatric settings to other doctor-patient interactions?

Whitgob: The pediatric setting introduces an added layer of complexity, because the patients are minors, and it is typically their caregivers who make the discriminatory comments. We go back to the top priority of caring for the patient. These findings do help providers of all disciplines think about how they might respond in similar situations, and opens the dialogue we all need to be having regarding these events.

RG: What are the next steps?

Whitgob: We want to continue this conversation throughout the institution and outside of it. Next steps also include creating faculty and resident development, to better prepare them for these events. This study highlights the prevalence of racism, sexism, and other bigotry and the importance of the conversation that needs to continue in this country. It is impossible to fully prevent discrimination from patients and families; we cannot predict who walks through the door of the hospital. We need to prepare faculty, staff, and trainees to respond to discrimination. No amount of preparation will make an event of discrimination less shocking in the moment, but it will give providers tools they can use to respond.

Featured image courtesy of Andrew Malone