According to Dr. Vinson, medical students are driving the awareness of the issue and conversations about it at Vanderbilt University. “I think there is a generational difference in how people respond to these things,” she said. “The younger generation has lived a life in which they haven’t seen blatant racism, so I think it is eye opening to them that someone would make a racist comment or demand to be treated by a physician of a different race.”
Explore this issue:December 2018
To help medical students and other physicians in training, Vanderbilt recently held a medical center-wide forum in which the administration discussed ways to deal with harassment from a patient. One way is for physicians in training to stand up for themselves and be honest about their credentials, said Dr. Vinson. Another avenue they are exploring is making the code of conduct physicians are expected to follow as visible as the code physicians have for patients. Fundamental to this code is mutual respect.
At the University of Virginia Health System, the administration has taken an even more systematic approach by developing a protocol, BEGIN (Breath, Empathy, Goals/values, Inquire, eNgage), that it hopes other institutions may be able to adopt. The protocol is built on a framework informed by the best available evidence on good interpersonal communication and focused on achieving a successful outcome.
“We’re trying to help people to have compassionate interactions with patients, where they can achieve the respectful outcome for everyone,” said Dr. Plews-Ogan. “A lot of our focus is to try to state clearly our values, without breaking the relationship, but trying to figure out ways to repair or strengthen the relationship.”
“This is the best outcome of all,” she said.
All medical faculty and staff are trained in using BEGIN in workshops designed to simulate a patient/physician encounter. Workshop attendees engage in role playing, using the acronym to become more comfortable with and proficient in creating the kind of interaction with the patient that will, hopefully, result in a better relationship, one in which both physician and patient stretch beyond themselves to understand better the differences that undergird racist behavior and beliefs.
To date, 10 workshops have been conducted over the past two months. Dr. Plews-Ogan said that the faculty and staff are still learning a lot about what makes an interaction more effective. “We have some promising data from a pilot study to suggest that people [who have undergone the training] do feel more comfortable when they are stepping into a situation that is a very tough circumstance to step into,” she said.