More than 40% of Latinx and Black residents experienced the more extreme forms of patient bias—racial epithets, bias-based refusals of care and requests to change physician—at least once in the last year.
Most female physician residents (87%) reported experiencing verbal or nonverbal sexual harassment, according to a new study examining the prevalence of biased patient behavior.
In a survey study of 232 internal medicine residents from three institutions in California and North Carolina, biased patient behavior ranging from belittling comments to refusal of care was experienced or witnessed by nearly all residents.
The frequency and extent of specific biased patient behaviors varied substantially, with belittling comments experienced on a monthly or weekly basis by more than half the residents and bias-based requests to change physicians experienced a few times a year by one-third of residents, according to the study published in JAMA Network Open.
Biased patient behavior directed toward a physician’s race/ethnicity or national identity and gender identity or expression were witnessed very commonly, with 89% of residents and 74% of residents, respectively, reporting having witnessed at least one instance within the past year, the study found.
- At least once in the past year, 42% of residents reported witnessing patient behavior directed toward a physician’s sexual orientation.
- Behavior directed toward a physician’s Islamic faith also was common, as 40% of residents reported witnessing that behavior at least once within the past year.
- Asian residents reported the greatest prevalence of belittling and demeaning behaviors. All Asian respondents surveyed reported bias-based inquiries into their ethnic origins. Asian residents also experienced more role questioning than White residents, the study found.
The study authors noted that residency programs need to consider the Asian American trainee experience when designing programs to address patient bias. "Such support is particularly urgent given the increase in biased behavior and hate crimes toward Asian Americans in the time of COVID-19," the authors said.
Despite the problems, most residents (84%) do not report these encounters to institutional leadership, preferring instead to respond to incidences of patient bias on their own or debrief with friends, family, and team members, according to the study.
For women residents in particular, a common barrier to responding to biased patient behavior is a sense of futility, reflecting a culture that rarely holds abusers accountable, the study authors noted. "Harassment constitutes one of many gender identity–based inequities in medicine alongside gaps in salary, career advancement, and leadership that will require a concerted effort to address," they wrote.
"To address the issue of biased patient behavior, interventions are needed at the institutional and interpersonal levels," the study authors wrote.
"The high prevalence of biased patient incidents may be largely unknown by residency program directors and academic medical center leaders as evidenced by the 80% of residents who stated that they never reporting biased patient behavior 'up' within their institution," the authors wrote.
Most residents described prior training on biased patient behavior as below adequate, and only one-third felt confident in responding to biased patient behavior. Developing a deeper understanding of residents’ sense of futility in responding to bias will be necessary for effective development and implementation of trainings and policies, the study authors said.
At the institutional level, low use of a formal structure to address and report incidents may indicate either a lack of formal reporting processes, a lack of knowledge of existing processes, or a reluctance to engage in these processes for fear of negative repercussions.
Residency programs and health care systems should prioritize training and policies to address biased patient behavior and support affected residents, the study authors concluded.