By Elise Most
Prompted by their own experiences in the workplace, Stanford researchers published a paper in “Academic Medicine” last month exploring ways to combat discrimination against physicians by their patients.
The paper follows a 2015 survey of pediatric residents at Stanford, in which 15 percent of respondents answered that they had either experienced or witnessed discrimination against doctors by patients or patients’ families.
The paper found four main themes in approaching mistreatment by patients, according to Emily Whitgob ’02 M.F. ’15, medical fellow in pediatrics.
“The first one was assessing how sick the child is, and I think that forms all the other approaches,” Whitgob said.
Along with co-author Rebecca Blankenburg, clinical associate professor in pediatrics, Whitgob stressed that medical professionals’ first priority is ensuring that the patient is well cared for; doctors should postpone thought about how to handle discriminatory remarks in situations where a patient is at urgent risk.
According to the report, other steps physicians may take to reduce the effects of this mistreatment include strengthening relationships with involved families, participating in advance preparation and discussion about issues of discrimination and creating a positive, welcoming environment for trainees.
Even with preparation, though, caring for a child whose parents are discriminatory against the physician can be a difficult situation to navigate, the researchers said.
“We always want to take care of the child first and foremost but [also] figure out how do we protect our trainees at the same time,” Blankenburg said.
According to Whitgob, ensuring autonomy of trainees is vital to their well-being. There is a huge difference, she explained, between a trainee choosing to leave a toxic, discriminatory situation for their own health and their supervisor removing them in an effort to shield them.
“The outcome [of the latter situation] is the same, but it’s taken away the autonomy of the trainee who is already in a really vulnerable position,” Whitgob said.
Whitgob also said that instances of discrimination can have a deep impact on physicians. She related an incident in which a patient assumed that an intern was Jewish due to her last name. The patient then told the intern that he did not want to be helped by a Jewish doctor.
“I brought it up [in a morning meeting] a few days later,” Whitgob said. “There were probably 20, 25 people in the room, and several of them were in tears through this discussion. There were people who all chimed in talking about different instances of discrimination that could happen and wanting to feel supported and upset at the same incident.”
The experience prompted Whitgob to embark on the project that would become her and her colleagues’ recent paper.
While some instances of discrimination against physicians stand out clearly — for example, Blankenburg described a situation in which a patient made fun of one of her residents’ names — other instances can take more subtle forms that are harder to categorize. Some patients wish to be treated by doctors of their same gender, the researchers pointed out.
“I’m not saying that people shouldn’t have that, but it is tricky because a few steps later, you’re saying some other things that seem not to be tolerable,” Whitgob said.
According to Whitgob and Blankenburg, Stanford has guidelines countering discrimination between physicians or trainees, along with a task force that examines broader relations between medical staff and patients. However, the University lacks procedures for situations in which patients or their families discriminate against their physicians.
“We talk a lot about mistreatment, and that’s a huge topic in medical education, but it’s often mistreatment from the inside — how people higher up in the hierarchy discriminate, either implicitly or explicitly, [against] their trainees,” Whitgob said.
Alyssa Bogetz, pediatrics residency director and senior author of the paper, believes that one of the most important outcomes of their work has been the resulting increase of discussion on the topic of discrimination. Whitgob and Blankenburg agreed that although there was some dialogue before its publication, the paper heightened conversation around discrimination by patients.
“The paper has opened the door to people being able to come out and say, this happened to me,” Bogetz said.
Both Whitgob and Blankenburg believe that more frequent discussion throughout the medical training process will help ameliorate the situation, both at Stanford and across the country. At the same time, they feel fortunate that Stanford backs up its physicians in cases of discrimination.
“This can’t be fully prevented until we live in a society where there is no bigotry,” Blankenburg said. “So we have to prepare faculty, residents, medical students and staff to deal with it when it does happen.”