Physicians Who Experience Patient Prejudice Lack Resources

Tara Haelle

Disclosures

October 18, 2017

Hospital Policies

Most hospitals have some sort of policy for how to respond to situations of patient prejudice, but they're all over the map in substance, says Kimani Paul-Emile, JD, PhD, an associate professor of law and faculty co-director of the Stein Center for Law & Ethics, Fordham Law School, New York City.

"There's an awareness that hospitals need to have policies in place, but there doesn't appear to be a consensus on what an appropriate protocol would look like or what would constitute best practices in these circumstances," Dr Paul-Emile told Medscape. "In my experience, there's no standardized, default baseline response."

Dr Paul-Emile has written extensively about these ethically challenging situations and has created a framework for how to manage them.[1] She's currently leading focus groups to learn what resources doctors want for dealing with these situations so that she can compile their responses into recommendations for institutions. But the biggest need is not something that can be codified into policy: changing institutional norms so that physicians feel safer about reporting in the first place, she says.

"Even if you have the best possible policies, if you have a culture or norm of nonreporting because physicians are afraid of being ignored or accused of being overly sensitive, then people won't report," Dr Paul-Emile says. "Some institutions may need to shift their cultural norms to ensure that these incidents and people's experiences are taken seriously."

That rings true for Dr Whitgob, who was underwhelmed at the attending physician's response to her intern's experience. The attending called the situation "ridiculous," but "I don't think the gravity of the situation really hit her," Dr Whitgob says. "She didn't circle back at the end of the shift and say, 'I don't condone what happened and we're always here to support you.'"

The incident inspired Dr Whitgob to use structured interviewsto learn how Stanford faculty respond when trainees experience bigotry from patients. Of four themes that emerged, two addressed helping the trainee: (1) helping them depersonalize the event in the moment so that they could continue to provide professional care, and then (2) providing support during and afterward, including emphasizing the trainee's competence, reporting to hospital administration or a training director as needed, and empowering the trainee to come up with the next steps.[2]

Dr Padela led a study looking at all forms of discrimination that Muslim physicians experience, including from peers and supervisors, and found that 9% (255) had a patient refuse their care because they were Muslim.[3] One thing he believes could help is having more Muslim mentors for Muslim physicians, at least at larger academic centers where they can serve as mentors in research as well.

"A lot of diversity and inclusion efforts don't look at religious identity," Dr Padela says. "Particularly for a minority faith, that's a problem."

Many institutions offer confidential counseling and peer mentorship in general for trainees and faculty, but those resources don't necessarily meet providers' needs following incidents of patient bias.

"We need to be sensitive to physicians who have this particular experience and to those who witness these encounters but don't know what to do and feel powerless," Dr Paul-Emile says. "The entire team needs to understand that these encounters happen and know how to respond to them effectively."

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