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- Title
Resident Physician Experiences With and Responses to Biased Patients.
- Authors
de Bourmont, Shalila S.; Burra, Arun; Nouri, Sarah S.; El-Farra, Neveen; Mohottige, Dinushika; Sloan, Caroline; Schaeffer, Sarah; Friedman, Jodi; Fernandez, Alicia
- Abstract
Key Points: Question: How often do resident physicians encounter incidents of biased patient behavior, and how do they respond? Findings: In a survey study of 232 internal medicine residents from 3 institutions, biased patient behavior ranging from belittling comments to refusal of care was experienced or witnessed by nearly all residents. Forty-five percent of Black/Latinx residents experienced epithets or refusal of care, and most women (87%) experienced sexual harassment; however, most residents (84%) did not report these encounters to their institutional leadership. Meaning: Given the high prevalence of biased patient behavior, residency programs that aim to foster inclusive training environments should implement resident and faculty training and create patient reporting mechanisms. Importance: Biased patient behavior negatively impacts resident well-being. Data on the prevalence and frequency of these encounters are lacking and are needed to guide the creation of institutional trainings and policies to support trainees. Objective: To evaluate the frequency of resident experiences with and responses to a range of biased patient behaviors. Design, Setting, and Participants: A retrospective survey was sent via email to 331 second- and third-year internal medicine residents from 3 academic medical centers in California and North Carolina. First-year residents were excluded owing to their limited interactions with patients at the time of participant recruitment. Data were collected from August 21 to November 25, 2019. Main Outcomes and Measures: Descriptive statistics were used to report the frequency of experience of various types of biased patient behavior, residents' responses, the factors impeding residents' responses, and residents' experiences and beliefs regarding training and policies. Results: Overall, 232 of 331 residents (70%) participated; 116 (50%) were women; 116 of 247 (47%) were White (participants had the option of selecting >1 race/ethnicity); and 23 (10%) identified as lesbian, gay, bisexual, transgender, or queer. The frequency of resident-reported experience of types of biased patient behaviors varied. The most common behaviors—belittling comments and assumption of nonphysician status—were reported to be experienced 1 or more times per week by 14% of residents (32 of 231) and 17% of residents (38 of 230), respectively. Women, Black or Latinx, and Asian residents reported experiencing biased behavior more frequently. Forty-five percent of Black or Latinx residents (17 of 38) encountered instances of explicit epithets or rejection of care. All 70 Asian residents reported experiencing inquiries into their ethnic origins. Most women residents (110 of 115 [96%]) experienced role questioning behaviors, and 87% (100 of 115) experienced sexual harassment. The need to prioritize clinical care and a sense of futility in responding were the most common factors (cited by 34% of residents [76 of 227] and 25% of residents [56 of 227], respectively) significantly impeding responses to biased behaviors. Eighty-five percent of residents (191 of 226) never reported incidents to their institution. Eighty-nine percent of residents (206 of 232) identified training and policies as necessary or very necessary. Conclusions and Relevance: This survey study suggests that biased patient behavior is experienced frequently by internal medicine residents. Non-White and women residents reported experiencing a disproportionate burden of these incidents. Residents' responses rarely included institutional involvement. Residency programs and health care systems should prioritize training and policies to address biased patient behavior and support affected residents. This survey study evaluates the frequency of resident physician experiences with and responses to a range of biased patient behaviors.
- Subjects
CALIFORNIA; NORTH Carolina; ATTITUDE (Psychology); DISCRIMINATION (Sociology); ETHNIC groups; GROUP identity; HOSPITAL medical staff; INDUSTRIAL safety; RESEARCH funding; STEREOTYPES; SURVEYS; SEXUAL minorities; RETROSPECTIVE studies; PATIENTS' attitudes; PHYSICIANS' attitudes; OFFENSIVE behavior; DESCRIPTIVE statistics
- Publication
JAMA Network Open, 2020, Vol 3, Issue 11, pe2021769
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2020.21769