P. Chandrashekar is a second-year medical student, Harvard Medical School, Boston, Massachusetts.
S.H. Jain is adjunct professor of medicine, Stanford University School of Medicine, Palo Alto, California, and president and chief executive officer, SCAN Group and Health Plan, Long Beach, California.
Acad Med. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S33-S43. doi: 10.1097/ACM.0000000000003682.
The duty to care for all patients is central to the health professions, but what happens when clinicians encounter patients who exhibit biased or discriminatory behaviors? While significant attention has focused on addressing clinician bias toward patients, incidents of patient bias toward clinicians also occur and are difficult to navigate.Clinicians anecdotally describe their experiences with patient bias, prejudice, and discrimination as profoundly painful and degrading. Though this phenomenon has not been rigorously studied, it is not unreasonable to postulate that the moral distress caused by patient bias may ultimately contribute to clinician burnout. Because women and minority clinicians are more likely to be targets of patient bias, this may worsen existing disparities for these groups and increase their risk for burnout. Biased behavior may also affect patient outcomes.Although some degree of ignoring derogatory comments is necessary to maintain professionalism and workflow, clinicians also have the right to a workplace free of mistreatment and abuse. How should clinicians reconcile the expectation to always "put patients first" with their basic right to be treated with dignity and respect? And how can health care organizations develop policies and training to mitigate the effects of these experiences?The authors discuss the ethical dilemmas associated with responding to prejudiced patients and then present a framework for clinicians to use when directly facing or witnessing biased behavior from patients. Finally, they describe strategies to address patient bias at the institutional level.
照顾所有患者是医疗保健专业人员的核心职责，但当临床医生遇到表现出偏见或歧视行为的患者时，该怎么办？虽然已经有很多关注的焦点放在解决临床医生对患者的偏见上，但患者对临床医生的偏见事件也时有发生，而且很难应对。临床医生们从轶事描述中得知，他们经历过患者的偏见、偏见和歧视，这些经历非常痛苦和有辱人格。尽管这种现象尚未经过严格研究，但合理假设患者偏见引起的道德困境最终可能导致临床医生倦怠。由于女性和少数族裔临床医生更有可能成为患者偏见的目标，这可能会加剧这些群体的现有差距，并增加他们倦怠的风险。偏见行为也可能会影响患者的治疗效果。虽然在保持专业性和工作流程方面，忽略贬低性评论在某种程度上是必要的，但临床医生也有权在不受虐待和侮辱的工作场所中工作。临床医生应该如何协调始终“将患者放在首位”的期望与他们受到尊重和尊严对待的基本权利？医疗机构如何制定政策和培训，以减轻这些经历的影响？作者讨论了与应对有偏见的患者相关的伦理困境，然后为临床医生提供了一个框架，以便在直接面对或目睹患者的偏见行为时使用。最后，他们描述了在机构层面上解决患者偏见的策略。
