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How Physicians Should Respond to Racial, Ethnic, or Religious Bias

STANFORD, CA — Especially after a contentious presidential election, issues of racial, ethnic, and religious bias are now part of the national conversation.

A new study published online by the journal Academic Medicine emphasizes that physicians aren’t exempt from being the victims of discrimination.

"We think so much about doctors mistreating trainees, and we also talk about clinicians mistreating patients and discrimination in that direction," said lead author Emily Whitgob, MD, a fellow in developmental-behavioral pediatrics at Stanford. "But we don't talk about it in this direction, and it happens."

Whitgob cites a 2015 survey of Stanford pediatric residents indicating that 15% had experienced or witnessed medical trainees being mistreated by patients or their families. In the new report, study authors detail strategies clinicians can use to deal with discrimination.

Whitgob said a personal experience with discrimination inspired her to initiate the study. "An intern I was supervising came to me very disturbed one day: Her patient asked if she was Jewish — because he didn't want a Jewish doctor," Whitgob said. "My intern isn't Jewish, but I am."

When Whitgob told other doctors about the experience at a weekly meeting, she said she was surprised by the reaction. "Half of the room was in tears" as they talked about the difficulties of facing discrimination from patients, she recounted. "They're women, people of color, different religions — and feeling very powerless."

For the review, researchers recruited 13 physicians from Stanford's pediatric residency program evaluation committee, each with responsibilities for supporting and teaching doctors in training. "In the case of a discriminatory event, these people would be at the forefront," Whitgob said. "They are there for residents to go to, and they want to be there."

Co-author Alyssa Bogetz, MSW, the educational program developer for Stanford's pediatrics residency program, conducted 75-minute interviews with those physicians on how they would advise their trainees to respond and how they would themselves respond to three scenarios of discrimination. One scenario involved racial discrimination, and the other two involved religious and gender discrimination.

Several recommendations emerged during analysis, including that, in the case of an emergency, doctors should ignore discriminatory remarks and focus on providing urgent medical care. Participants also agreed that it is best for trainees to depersonalize the event.

Finally, most, but not all, of the participants said that identifying, naming, and validating the emotional experience underlying the discriminatory remarks was important for establishing trust with the families. Trainees were urged to "cultivate a therapeutic alliance,” by acknowledging the discriminatory remarks and exploring underlying reasons for them.

Four of the physicians recommended simply focusing on immediate medical needs, while letting the patients and families know that discrimination of any sort is unacceptable.

“Discrimination toward trainees by patients and families is an important issue. As this type of mistreatment cannot be fully prevented, effective preparation is essential,” study authors concluded. “Effective response strategies exist and can be taught to trainees to empower responses that protect learners and preserve patient care.”