Fordham University School of Law, New York, New York (K.P.).
University of California, San Francisco School of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California (J.M.C., M.W.).
Ann Intern Med. 2020 Sep 15;173(6):468-473. doi: 10.7326/M20-0176. Epub 2020 Jul 14.
Some patients engage in behavior or use language that demeans clinicians on the basis of their social identity traits, such as race, ethnicity, sex, disability, gender presentation, and sexual orientation, and some patients even request reassignment of involved clinicians. Despite the importance and prevalence of this problem, many medical centers lack an organizational approach for addressing patient conduct. Policy development can be daunting because organizations may encounter various barriers, including reluctance of staff to have difficult conversations about race or other identity traits; uncertainty about what constitutes an appropriate response to the spectrum of demeaning behaviors and who should make this determination; what, if any, support should be offered to targeted clinicians; whether these incidents should be reported and to whom; and whether the medical center's response should differ depending on whether nurses, trainees, or other clinicians are involved. These determinations have important implications for patients' informed consent rights, clinicians' employment rights, and medical centers' obligations to protect patients' health while adhering to workplace antidiscrimination laws and institutional commitments to diversity, equality, and inclusion. This article addresses these considerations and offers guidance to organizations on devising effective policies that meet the needs of medical centers, patients, and health care workers across services and roles, including physicians, nurses, and trainees.
有些患者会根据医生的社会身份特征（如种族、民族、性别、残疾、性别表达和性取向）贬低临床医生的行为或使用贬低的语言，有些患者甚至要求更换相关临床医生。尽管这个问题很重要且普遍存在，但许多医疗中心缺乏解决患者行为问题的组织方法。政策制定可能会令人生畏，因为组织可能会遇到各种障碍，包括工作人员不愿就种族或其他身份特征进行艰难对话；不确定哪些行为构成了对各种贬低行为的适当回应，以及应由谁做出这一决定；应向目标临床医生提供哪些支持；这些事件是否应报告以及应向谁报告；以及医疗中心的反应是否应根据涉及护士、受训者还是其他临床医生而有所不同。这些决定对患者的知情同意权、临床医生的就业权以及医疗中心在遵守工作场所反歧视法和机构对多样性、平等和包容的承诺的同时保护患者健康的义务都有重要影响。本文讨论了这些考虑因素，并为组织提供了指导，帮助其制定符合医疗中心、患者以及包括医生、护士和受训者在内的各服务和角色医护人员需求的有效政策。
