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Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

One patient requests a white, male doctor even though the physician currently attending to her, a Muslim woman, is the most qualified physician on staff to perform the delicate procedure that she needs. Another repeatedly makes a racist remark about a resident that the resident's attending physician hears but doesn't address.

Anecdotes about prejudiced patients abound in medicine, but what do we know about how often this really occurs? What does it mean for patient care? These are the questions we sought to address in a WebMD/Medscape survey, produced with STAT, of 934 consumers and 822 physicians on the topic of bias. Here's what they told us.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

The majority of physicians who responded to the survey—59%—say they've heard an offensive remark about their personal characteristics or background from a patient within the past 5 years. The most common comments are about age, but a physician's ethnicity/national origin, gender, and race are also reasons for biased comments. In the past 5 years, almost one half of physicians say they've had a patient request a different clinician on the basis of their personal characteristics or background or the characteristics or background of a clinician to whom they were referred. About one quarter of physicians told us that in that same period, a patient has written a complaint about them because of their personal characteristics or background.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

We also asked patients which characteristics they avoid when selecting a healthcare provider. The most common reason for avoiding a healthcare provider is an accent that's difficult to understand. Almost one third (29%) say that they have avoided a healthcare provider in the past 5 years on the basis of the provider's personal characteristics or would have if the circumstances arose. Only about 1 in 10, however, have changed to a different provider because of a characteristic such as gender or race.

An important point to note is that whereas patients only see about 19 providers in their lifetime,[1] physicians see an average of 19 patients per day, making physicians much more likely to encounter incidents of bias, even if the actual number of patients who are biased is relatively small.[2]

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

When choosing a primary care provider, some patients say they prefer that the provider have similar characteristics to themselves. For example, 20% of patients say they prefer a primary care provider who is the same gender, with women (28%) more likely than men (12%) to say so.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Female and male physicians, it turns out, experience bias in very different ways. For starters, more female physicians (65%) than male physicians (55%) report experiencing bias. Women more often than men hear comments about their gender, age, and weight. Male physicians, in contrast, are more likely than women to hear biased remarks about their religion.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Almost one half of physicians say that over the past 5 years, they've had a patient request to see someone other than them because of their personal characteristics or background, or had a patient request someone other than the physician they referred them to because of that physician's personal characteristics or background. Of this group, over two thirds say they've responded by referring the patient to another clinician in the same practice or a different practice.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Although it's common for physicians to experience bias, the good news is that a majority of physicians report that the clinical impact of these situations is minimal. In fact, a majority of physicians say that referring a patient to another clinician had no impact on care.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Although the clinical impact of bias may be minimal, the emotional impact may be profound for some physicians. Only about 1 in 10 physicians say they've ever refused to care for a patient because of that patient's negative bias toward themselves or a colleague. Of those physicians who say they've refused to treat a biased patient, however, more than one quarter say the experience has had a strong emotional impact on them. Almost twice as many female physicians (40%) report being strongly affected emotionally compared with their male counterparts (21%).

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Almost one quarter of physicians who've experienced bias within the past 5 years say that at some point, they've documented the incident in a patient's medical record. Only 10% of that group say they've reported it to an authority.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Perhaps not surprising, physicians who work in emergency medicine—a specialty in which patients are typically not able to choose their doctor—are more likely to report hearing an offensive remark from patients. Whereas 59% of physicians overall report having heard a biased comment from a patient within the past 5 years, 83% of emergency medicine physicians say they've heard such a comment, most commonly about their gender and age. In response to these incidents, these same physicians are more likely than others to make a note in a patient's medical record.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

In addition to specialty, race also plays a part in how likely a physician is to experience bias from patients. Whereas 59% of all survey respondents reported hearing bias within the past 5 years, 70% of African American/black physicians and 69% of Asian physicians reported having heard such a remark within this same period. Being female, younger than 34 years, and not white are more likely to make a physician a target of bias.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

African American/black physicians are more likely to hear biased remarks about race (39% vs 19% total) and ethnicity/national origin (30% vs 22% total).

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Asian physicians are more likely to hear biased remarks about their ethnicity/national origin (43% vs 22% total) and race (32% vs 19% total). In response, though, Asian physicians are less likely to have refused to care for such a patient.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

Hispanic physicians are more likely to hear remarks about their ethnicity/national origin (37% vs 22% total) and their accent (16% vs 10% total).

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

According to the physicians we surveyed, most institutions don't have a formal process for handling bias or training physicians on how to handle bias. Only 16% of physicians say that their institution has a formal process for reporting patient discrimination, and fewer than 1 in 5 say their institutions provide any training on how to manage patients who express negative bias.

For more on how the medical community handles incidents involving biased patients, see our article, Physicians Who Experience Patient Prejudice Lack Resources.

Patient Prejudice: When Credentials Aren't Enough

Stephanie Cajigal; Laurie Scudder, DNP, NP | October 18, 2017 | Contributor Information

More about the WebMD survey: Funded and operated by NORC at the University of Chicago, AmeriSpeak is a probability-based panel designed to be representative of the US household population. Randomly selected US households are sampled with a known, non-zero probability of selection from the NORC National Sample Frame, and then contacted by US mail, telephone, and field interviewers (face to face). AmeriSpeak panelists participate in NORC studies or studies conducted by NORC on behalf of governmental agencies, academic researchers, and media and commercial organizations. NORC at the University of Chicago is an independent research institution.

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Physicians Who Experience Patient Prejudice Lack Resources

A WebMD/Medscape survey conducted in partnership with STAT found that 59% of doctors have experienced bias from patients. So, what can physicians do in these situations?
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