When Patients Discriminate

For medical providers to treat all their patients justly - without discrimination and judgement - is a mindset that medical students are frequently taught to embrace throughout their medical training. It is a mindset that we must be reminded of constantly since all human beings, medical providers included, naturally carry with them their own subconscious biases. When acted upon, these biases can actually harm patients, which violates the sacred oath all physicians take to “do no harm.” The mismanagement of pain in minority patients, for instance, is a well-documented example of how providers’ limited awareness of their own biases can cause their patients to suffer.

What is not often discussed nor taught in medical education is the reverse situation: patient discrimination towards their medical providers. One survey of 800 US physicians showed that 59 percent of them experienced prejudiced remarks from patients. Most of these remarks centered around race and ethnicity, age, gender, accent, and religion. I find it odd that there is no place in my formal medical education for discussing a phenomenon that will affect more then half of my fellow peers. What is more shocking to me is that medical students who are more vulnerable to such microaggressions - a person of color or an immigrant (or even non-immigrant) with a thick Mexican accent - should have to grapple with the fear of being unjustly demeaned or dismissed by a prejudiced patient on a daily basis. As a Muslim woman of color who wears a scarf, or hijab, around her hair, this fear is painstakingly real for me.

As I progressed through my second year of medical school, the prospect of finally interacting with patients regularly became much more real to me, as did my fears of receiving insulting remarks. And so I began to think - how will my patients perceive me, a brown female in a headscarf? Will I be ridiculed in spite of my commitment to medicine simply because I look different? A quick Google search justified my fears; discrimination from patients is not only disturbingly common, but there are rarely outlets or support systems in place to allow providers to express the toll such experiences can have on their physical and emotional health, including increased burnout. Furthermore, lack of formal training on how to deal with dismissive patients that make requests based on prejudiced beliefs (i.e. requesting a white doctor when assigned a black doctor,) can leave physicians at a loss for how to navigate such absurd situations. Thus, the response of the medical provider has been to simply bear the brunt of patients’ insults or heed patients’ requests to have a different provider.

As co-president of the Muslim Student Association, I organized a round-table discussion titled: “Facing Provider Discrimination in the Healthcare Field.” The purpose of this discussion was to allow students to safely share any concerns or negative experiences they may have regarding prejudiced patients. The ultimate goal of the discussion was to equip medical students with concrete ways they could cope with racism, xenophobia, homophobia, Islamophobia or other forms of discrimination. Physicians of different colors, genders and faiths were also invited to the discussion to shed light on how they deal with this reality in their daily lives.

The response from the student body was robust. The event was at maximum capacity with 40 attendees as medical students of all years, residents, attending physicians and administrators took their seats at the roundtable. What followed for the next 90 minutes was sobering. All levels of medical provider shared frustrations and hurt that followed incidents of discrimination from patients, including a radiology resident who has had patients unaccepting of the fact that he, a man of color, was their physician and credentialed to treat them. Story after story filled the room until the discussion time had elapsed. Clearly, I was not alone in my fears.

So where then, does this leave medical providers with how they should navigate these difficult situations? One attending physician talked about the importance of securing healthy outlets of expression, such as formal discussions (like this one) or informal ones on a regular basis, be that a friend you vent to on the phone or alone time with a journal. Expressing yourself may not prevent future verbal insults, but can help you to heal and process the mini-injustices that can take place in the patient-physician relationship. The solution that should follow next is for institutions to evaluate the role that patient prejudice plays at their institutions by consulting the ones victim to it - medical providers - and consider developing strategies and hospital policies for dealing with a patient who, for example, engages in hate speech towards a provider because of the color of their skin. A 2016 New England Journal of Medicine article titled “Dealing with Racist Patients” concluded that stable patients who refuse treatment from certain medical providers for bigoted reasons should be asked to seek medical care elsewhere. Perhaps they should be, since allowing patients to openly act on racist, xenophobic or otherwise discriminatory beliefs essentially permits dehumanization of medical providers.  

I do not think that I would ever refuse to care for a bigoted patient, even an Islamophobe hurling words of hate at me. But, as a medical provider, I should also not have to live in fear of being insulted or threatened for the clothes I choose to wear or the color of my skin. As a medical provider, I am also a human being, and therefore worthy of respect even from our most vulnerable patients whom we serve and treat to the best of our abilities.

Sara Khan is a third-year medical student at Albany Medical College. She is pursuing a career in Medicine/Pediatrics.

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