Addressing Patient Bias Toward Health Care Workers
Authors: Beril Cakir
Journal: Annals of Internal Medicine (2021)

LettersFebruary 2021Addressing Patient Bias Toward Health Care WorkersFREEBeril Cakir, MD, MPHBeril Cakir, MD, MPHCarolinas Hospitalist Group, Carolinas Medical Center, Atrium Health, Charlotte, North CarolinaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1397 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Paul-Emile and colleagues (1) address the lack of policies at many medical centers dealing with patient abuse that is mostly due to racial bias toward clinicians. They offer guidance on how to create effective policies for a problem experienced by more than one half of physicians (primarily those who are Black and Asian). Two other less-studied stressors on physicians related to this topic also require legal protective measures.Because hospital reimbursements from Medicare are tied to Press Ganey patient satisfaction scores, most physician incentive structures include the need for high scores. In 1 study involving 678 physicians, White physicians had higher satisfaction ratings than other physicians and received a greater number of positive comments (2). DeLoughery and associates state that, because race does not influence physician competence, this biased measure of physician quality should not be used to evaluate physician skill or ability (2). Physicians already exposed to unfair, biased behavior from patients should not be penalized for something they cannot control; most likely, they will not receive high scores from patients who engage in such behavior. The emotional and financial ramifications of biased patient behavior toward minority physicians have yet to be further studied.Racially biased behavior against physicians originates from not only patients but also hospital staff, particularly nurses. Unfortunately, only a few studies are available on this topic. One study on interactions between nurses and female physicians identified that nurses would be more willing to provide service to male physicians because of traditional power imbalances in the relationship and could be more hostile toward female physicians (3). When race is also involved in this equation, sex-biased discrimination was reported to be very significant (4). In another study, 44% to 71% of physicians of different races reported experiencing racial and ethnic discrimination at work (5).Despite the presence of cultural diversity and antidiscrimination policies in hospitals, minority physicians can be the target of microaggressions in terms of verbal or nonverbal insults coming from nurses. Friction during interactions may be considered a failure in simple communication skills when these concerns are taken to leaders (who may be White and might never have experienced a similar incident). Physicians may choose to suffer silently not to damage their reputations. Again, the effects of negative interactions in the workplace due to subtle discrimination by hospital staff on minority physicians' well-being, productivity, success at work, and opportunity for promotion in their career remain undefined. Awareness of this issue and protective policies in medical centers are warranted.References1. Paul-Emile K, Critchfield JM, Wheeler M, et al. Addressing patient bias toward health care workers: recommendations for medical centers. Ann Intern Med. 2020;173:468-73. doi:10.7326/M20-0176 LinkGoogle Scholar2. DeLoughery EP. Physician race and specialty influence Press Ganey survey results. Neth J Med. 2019;77:366-9. [PMID: 31880269] MedlineGoogle Scholar3. Zelek B, Phillips SP. Gender and power: Nurses and doctors in Canada. Int J Equity Health. 2003;2:1. [PMID: 12605720] CrossrefMedlineGoogle Scholar4. Coombs AA, King RK. Workplace discrimination: experiences of practicing physicians. J Natl Med Assoc. 2005;97:467-77. [PMID: 15868767] MedlineGoogle Scholar5. Nunez-Smith M, Pilgrim N, Wynia M, et al. Race/ethnicity and workplace discrimination: results of a national survey of physicians. J Gen Intern Med. 2009;24:1198-204. [PMID: 19727966] doi:10.1007/s11606-009-1103-9 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: Carolinas Hospitalist Group, Carolinas Medical Center, Atrium Health, Charlotte, North CarolinaDisclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1397. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAddressing Patient Bias Toward Health Care Workers: Recommendations for Medical Centers Kimani Paul-Emile , Jeffrey M. Critchfield , Margaret Wheeler , Shalila de Bourmont , and Alicia Fernandez Metrics February 2021Volume 174, Issue 2Page: 288KeywordsBehaviorConflicts of interestDisclosureEmotionsHealth care providersMedicareMotivationRacial and ethnic discriminationRacial and ethnic issues ePublished: 16 February 2021 Issue Published: February 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...