4 strategies for dealing with patient discrimination of trainees

An unfortunate current reality of the medical profession is that the very patients physicians are trying to help can be incredibly discriminatory back.

This mistreatment, which includes any behavior disrespecting the dignity of another based on race, gender and religion, especially takes a toll on trainees. According to various studies published in the last five years, at least 17 percent but as many as 95 percent of trainees have faced discrimination from patients.

And while this type of discrimination cannot be prevented by medical staff, they can support trainees in learning how to react, preserve patient care and still feel empowered as a provider and an individual. A recent study, published in the Journal of the Association of American Medical Colleges, provides educators with some guidance on how to respond when a trainee experiences discrimination.

Based on interviews with 13 pediatric faculty educational leaders from Stanford (Calif.) University, researchers compiled the following four strategic responses.

1. Assess the medical need of the patient. This is the first step physicians and trainees should be taught to take when they experience discrimination, according to the responses. If it is an emergency, the discriminatory remarks should be ignored and no requests by patients for alternate providers should be granted.

2. Cultivate an alliance with the patient. If the patient is not in an emergent condition, some educational leaders recommended taking a constructive approach to discrimination. Because it is likely patients and patients' families remarks are misguided, faculty suggest building a rapport with families by trying to identify and validate what they are actually upset about — the patient's medical condition. In these instances, providers should focus on drawing a patient or family's attention away from the discriminatory remark and toward the patient's needs and the need to work as a team.

However, four of the 13 respondents felt this strategy gave credence to prejudice and could potentially reinforce discriminatory behaviors. They favored a more straightforward approach: simply explaining which providers are available and offering patients the option to go elsewhere for care.

3. Help trainees depersonalize the remarks. The educators stressed the importance of helping trainees understand that discriminatory remarks are a reflection on the person who delivers them, not the recipient. Though this may not help trainees feel more comfortable around the patient, it can help them reframe the experience constructively.

4. Create a safe learning environment. The study participants also acknowledged faculty must be committed to creating a safe learning environment among medical staff to help counteract any negativity from patients. As part of this, leaders should follow up with trainees one-on-one or in a group and use the events as learning experiences. Leaders should also grant trainees the autonomy to remove themselves from a situation when they feel their emotional response could compromise the quality of care.

For more details on these strategies, read the full report here.


More articles on integration and physician issues:

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Johns Hopkins researchers find hospitalist PAs cut costs, maintain quality
PwC: Well-designed primary care team can save $1.2M for every 10k patients

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