How Best to Care for Biased Patients

by Mary Beth Nierengarten •

Dr. Thompson also emphasized the importance of compassion and engaging patients in understanding the their fears, being aware that fear is usually the foundation of bias. “I generally ask what their concerns are and try to understand if [their biased statement] is a statement of fear at a time when the patient feels vulnerable,” she said. “I often will engage in a conversation, allowing them an opportunity to see another physician and also letting them know I care and I am qualified.”

Some humor also may help, she said, particularly in patients who are curious and show implicit bias. For some patients with explicit bias, however, she said the best recourse may be to get them a physician they are more comfortable with if they still show mean-spirited beliefs or behaviors after the physician has tried to understand their fears. “I am also human, and persistent mean-spirited and racist comments feel like attacks and can disrupt the bond of the patient–physician relationship that is necessary for patient-centric health care,” she said.

According to Dr. Thompson, in a specialty such as otolaryngology, in which minority physicians are underrepresented, it is easier to find a replacement for a patient who prefers a white doctor and, perhaps, a white, male doctor. “Any underrepresented minority physicians in otolaryngology really stick out to non-minority patients,” she said. However, she added, “When a patient questions my ability based on gender or race, I find speaking to my credentials, skill, and experience with confidence helps.”

Mary Beth Nierengarten is a freelance medical writer based in Minnesota.

The Begin Protocol

A framework developed at the University of Virginia Health System that employs the use of the acronym BEGIN can be used by faculty and trainees in a step-wise fashion to guide their interactions with a biased patient. The acronym stands for the following:

  1. B: Breath—Start with taking a breath to calm oneself, assess the situation, and determine whether to respond directly or get help.
  2. E: Empathy—Use empathy with the understanding that patients are not at their best when in the hospital or clinic. Use statements such as, “I know how difficult it must be … .”
  3. G: Goals/Values—State the goals/values of the hospital/clinic by emphasizing mutual respect between physician and patient.
  4. I: Inquire—Ask a curious question to help understand why the patient may hold the beliefs that he/she does, such as, “Can you help me understand what you’re really concerned about?” Try to understand the assumptions behind the belief or behavior.
  5. N: eNgage—Lay out for the patient what the plan is for the day, what is expected from him/her, and the goal of the treatment plan.