Physician and Trainee Experiences With Patient Bias

Area of Science:

• Medical Education
• Healthcare Professional Well-being
• Health Equity

Background:

• The increasing diversity of the clinical workforce leads to more frequent encounters where physicians are demeaned by patients based on social characteristics.
• Understanding physicians' perspectives on these biased encounters and their impact is crucial for developing effective institutional policies and training programs.

Purpose of the Study:

• To explore the range and perceived importance of patient-incited biased behaviors experienced by physicians and medical trainees.
• To identify barriers and facilitators influencing physicians' responses to biased patient encounters.

Main Methods:

• A qualitative study involving 50 participants (hospitalists, residents, medical students) across 3 campuses of an academic medical center.
• Data were collected through 13 focus groups using open-ended probes, with subsequent thematic analysis of transcribed discussions.
• Participants defined biased patient behavior, and data were independently coded by multiple investigators.

Main Results:

• Reports of biased behavior varied from patient refusal of care to explicit racist, sexist, or homophobic remarks, and belittling comments.
• Targeted physicians experienced emotional tolls including exhaustion, self-doubt, and cynicism; bystanders reported moral distress.
• Barriers to effective responses included lack of skills, inadequate institutional support, and perceived futility; participants desired training and clear policies.

Conclusions:

• Encounters with demeaning patients are challenging and emotionally taxing for physicians and medical students.
• Addressing biased patient behavior necessitates institutional commitment to developing policies and training programs.
• Creating a clinical environment that respects the diversity of both patients and physicians is essential.