“Things that happen commonly are that a medical student, resident, or fellow as part of a training team, a person usually with a darker skin tone, will be singled out by a patient and asked where they are from and where they received their training,” said Kimberly N. Vinson, MD, assistant professor of otolaryngology and assistant dean for diversity affairs at Vanderbilt University Medical School in Nashville. “It all kind of boils down to [the fact] that, [for some patients], unless their doctor looks like them, the patient thinks the doctor is not educated or equipped enough to take good care of them.”
Explore this issue:December 2018
Dana Thompson, MD, MS, chief of pediatric otolaryngology and professor of otolaryngology–head and neck surgery at Northwestern University’s Feinberg School of Medicine in Chicago, who, after more than 30 years of practicing medicine, said she could write a book about her experiences of racial and gender bias as a black female surgeon, said that she sees three trends in patients who are uncomfortable with being treated by a physician whose appearance differs from theirs: those who are surprised or intrigued by the difference and express curiosity about the physician’s background, those who have implicit bias without overt anger but say insulting things like, “I am not used to seeing a black doctor,” and those with explicit bias who show mean-spirited behaviors and beliefs that may be fueled by intrinsic racism.
For institutions, Dr. Thompson emphasized the need for cultural training and full support for trainees who may find themselves in a situation with a biased or racist patient. “Supporting trainees when it happens is necessary, and having immediate debriefing and a show of support to the trainees is essential,” she said. “How we show support or do not show support models the behavior and response moving forward.”
Both Drs. Vinson and Francis also emphasize the importance of faculty and staff support of these physicians in training. “Everyone should be aware that certain members of our specialties do deal with these things and [should] be supportive when their colleagues are in these situations,” said Dr. Vinson.
Dr. Francis was even more pointed. “The solution cannot be isolated to the potential victim of racism but must represent a unified front by administration, senior physicians, and nursing that reflects the values of inclusion and mutual respect of the organization,” he said.
Addressing the Problem
All sources underscored the importance of addressing this problem and not “sweeping it under the rug,” as Dr. Francis phrased it. Although physicians may have ignored biased comments in the past, the younger generation, who are more diverse and less tolerant of biased behaviors, seems to be leading the drive to more directly and systematically address how to deal with a patient who exhibits biased beliefs and behaviors.