۵ ways to support medical residents facing patient discrimination

Incidents of identity-based patient bias are disturbing for all health professionals, but they can present especially intense challenges for physicians in training due to the number of patient interactions they experience. A lawyer specializing in anti-discrimination and health law recommends a five-step approach to helping colleagues during a real-time discrimination incident and addressing discrimination organization-wide.

Following are highlights from an article published in the AMA Journal of Ethics^® (@JournalofEthics) by Kimani Paul-Emile, PhD, a professor at Fordham University School of Law, with recommendations based on lessons drawn from grand rounds she conducted at U.S. medical organizations.

“Despite the startling statistics regarding patients’ treatment of trainees, data and overwhelming anecdotal evidence show that organizations are not adequately supporting their trainees in dealing with these abusive patient encounters. Indeed, 50% of surveyed residents who experienced or witnessed patient discrimination didn’t know how to respond, while 25% believed that nothing would be done if hospital leadership were notified,” Paul-Emile wrote, citing a 2016 study.

She suggests five protocols that together “constitute a clinically, ethically and legally appropriate means of supporting trainees while protecting the interests of patients and health care organizations.”

Assessment. When an incident occurs, a supervisor should immediately acknowledge the patient’s misconduct and determine whether the resident wishes to handle the situation on her own.

“If the trainee doesn’t, then the supervisor must intervene to inform the patient that the trainee is qualified to treat patients and that bigoted conduct will not be tolerated,” Paul-Emile wrote. “After conferencing with the trainee, it is imperative that, whatever is decided, the supervisor model appropriate behavior and not force the trainee to accede to the patient’s biased demands, as this may violate both employment and education anti-discrimination laws.”

Debriefing. After the event, an affected resident should have an opportunity to talk frankly about it, preferably with someone he trusts.

“It’s also important that supervisors and the organization not minimize the encounter and instead commit to understanding how the trainee may have experienced the harassment or rejection with an eye towards crafting a meaningful future response,” Paul-Emile added.