It was Dr. Emily Whitgob's first year in a supervising role at Stanford Hospital when she first encountered discrimination from a patient.
The father of a pediatric patient took one look at her intern's name tag and asked if the last name was Jewish.
“I don't want a Jewish doctor,” the man said. “I'm from Palestine.”
The intern explained that she had taken her husband's last name, and that she herself was not Jewish. The father accepted this explanation, but as the intern finished treating his child and was about to pass the family off to a more specialized doctor for a surgical consultation, the father had a second request.
“The consultant who's coming down to take care of my child - is that doctor going to be Jewish?” he asked. “I really don't want a Jewish doctor.”
When the intern later relayed this encounter to Whitgob, it led to an important question: How should doctors and their supervisors handle discriminatory requests?
Shocked by her resident's experience and the lack of guidance provided by hospitals and medical schools, Whitgob decided to create new guidelines on how to handle discrimination from patients, now published in the journal Academic Medicine.
Whitgob's guidelines fold into a larger industry-wide effort to improve young doctors' experiences. Medical schools and hospitals have begun speaking openly about the intense pressure students face, the bullying they may encounter from supervisors and the unusually high rates of depression and suicide among medical students and doctors.
But administrators have seldom discussed the discriminatory ways that patients may treat doctors of certain ethnicities, religions, genders and cultures, said Whitgob, who is a fellow in developmental behavioral pediatrics at Stanford School of Medicine. This is particularly important to change ― not only to create a welcoming environment for all doctors, but also because it may help address the high dropout rates of medical students of color.
“We need to train the people in the institution on how to be prepared, because we're not going to be able to prevent [discrimination],” she said. “Talk about it frequently, and then people can set up their own boundaries.”
35 percent of medical school graduates have faced racial or gender harassment and discrimination.
Research on the issue is rare. One 2011 survey of 377 medical school graduates found that 35 percent of them had experienced intimidation, harassment and/or discrimination from patients, and that it was primarily based on race, gender and culture.
Consider the case of Tonya Battle, a black nurse who sued her hospital in Flint, Michigan because she was barred for caring for a white baby in the neonatal intensive care unit. The hospital enforced this ban for one month at the request of the baby's father, who had a swastika tattoo, even though the hospital lawyer said his request couldn't be granted.
Not all discrimination is as clear cut as cases like Battle's or the incident with Whitgob's resident. Asking for a doctor of the same gender could be interpreted as helping comply with a patient's religious beliefs, for example. While the request may not make a patient a bigot, it does present a series of escalating questions about how far hospitals should go to accommodate patient requests for any type of doctor. And doctors themselves still need training on how to handle patient rejection in the moment that it happens.
Whitgob's guidelines for handling patient discrimination
Whitgob asked 13 colleagues at Stanford, who remained anonymous, to share how they would respond to discrimination, based on a few real life case studies, including her own intern's experience. She summarized the senior doctors' answers into four basic guidelines that she hopes will become standard procedure in hospitals and medical schools.
Step 1: Ignore comments during an emergency
If a medical matter is urgent or if it is an actual emergency, simply ignore or respond to the discriminatory remarks, rather than indulge in the parents' request for a staff change.
“It's an urgent versus routine thing,” one doctor said. “If we're just doing a routine checkup, it's one thing. If you're here to deliver a baby or the baby urgently needs attention and I'm the only person to provide the care, then there's not a lot of choice in the matter.”
Step 2: Focus on the shared goal of treatment
Every doctor agreed that it was important to redirect patients so that they focused on the shared goal of treatment. But from there, the doctors split: Some suggested trying to reason or even empathize with patient anxieties, while others suggested zero tolerance for discriminatory views.
Notably, the four doctors with the most clinical and teaching experience advocated zero tolerance to Whitgob:
If I think there's some mistaken thought that is contributing to this prejudice or to not wanting this provider to take care of the child, then I'm willing to go there. But if it seems to be a situation of just prejudice, then I'm not going to get into that conversation. We're just going to focus on, “These are our providers. This is what we do. Let's focus on getting what you came here for.”
Step 3: De-personalize the event
While it's difficult to do, after the event, residents should find a way to relieve their own emotions about the discrimination and re-frame it as the patient's problem. Support from supervisors may be key to helping them process the experience.
“The emotional heaviness of this can be alleviated if you rest on your professional values,” said one doctor.
Step 4: Hospitals need to demonstrate support
It's important that hospital administrations demonstrate to medical staff that they are valued members of the team, and that any kind of mistreatment will not be tolerated.
They must acknowledge instances of discrimination and mistreatment and support medical trainees' decisions on how to move forward with care.
“Sitting down and having a one-on-one or even having the whole team discuss it is important,” said one doctor. “Because I think all residents will be discriminated against, no matter what, at some point in their career.”
Prejudice is everywhere, and it can walk into hospitals at any time.
Whitgob's paper is a small, qualitative study of a single hospital, but she does hope that in raising the issue and attempting to come up with a set of guidelines for the inevitable encounter with a prejudiced patient, medical schools and hospitals can begin talking to staff about discrimination from patients early and often.
“Having people be aware and prepared is, in some cases, all we can ask for,” Whitgob concluded. “But I think that it will really help people be not quite as dumbfounded when these things happen.”
And hopefully, preparing for prejudiced patients will help hospitals and medical institutions continue on their transformation toward safe, supportive working environments for new doctors.
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