ARTICLE: Confronting Bias and Discrimination in Health Care-When Silence Is Not Golden

AUTHORS: Lisa Cooper, Mary Catherine Beach and David Williams

JOURNAL: JAMA Intern Med. 2019 Oct 28. doi: 10.1001/jamainternmed.2019.4100. [Epub ahead of print]

In this issue of JAMA Internal Medicine, Wheeler et al1 report results from a novel qualitative study in which the investigators examined how physicians and trainees perceive, react, and respond to incidents of biased patient behavior. Study participants reported varied experiences with discriminatory patient behavior, ranging from mildly disparaging comments to openly racist, sexist, or homophobic stereotyping remarks and absolute refusals of care. They also described myriad reactions to these situations, including pain, fear, anger, and confusion. Barriers to appropriate responses included a lack of skills in confronting patients exhibiting biased behavior, lack of support from colleagues and guidance from the institution, and uncertainty about whether responding to these experiences would be perceived as unprofessional. This study provides insights into the gravity of the problem of discriminatory patient behavior, raises key unanswered questions, and calls for action from the medical profession.

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