Center for Women's Health Research, University of Wisconsin-Madison, Madison, WI, USA.
School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
J Gen Intern Med. 2021 Jun;36(6):1553-1560. doi: 10.1007/s11606-021-06696-7. Epub 2021 Mar 29.
Workplace discrimination negatively affects physicians of color personally and professionally. Although the occurrence of discrimination from patients has been visible in social media, popular press, and personal essays, scant research exists on patients as a source of discrimination directed at physicians of color.
To explore practicing general internists' experiences observing or interacting with patients exhibiting discriminatory behavior directed at physicians of color.
A qualitative study with in-depth, semi-structured, one-on-one telephone interviews conducted and recorded between May and September 2019.
A purposive sample of 24 general internists practicing at 12 academic health centers in the USA: 14 self-identified as White and 10 as a physician of color, which included Asian, Black, Native American, and self-identified other race.
Four coders analyzed the transcribed and verified interview text; thematic analysis was used to inductively identify cohesive themes and subthemes.
Analyses revealed four major themes: (1) assumption that a legitimate doctor is White, male, and able-bodied; (2) legacy of the Black experience; (3) working through the struggle of discrimination; and (4) ethical dilemma of providing care to discriminatory patients. In addition to discrimination from patients based on a physician's race or ethnicity, participants described experiencing or observing discrimination based on a physician's gender and disability status. Participants generally expressed a need for greater support from colleagues and more guidance from institutional policies.
General internists practicing in academic settings reported observing or experiencing discrimination from patients based on the physician's race, ethnicity, gender (or their intersection), and disability status and the ethical dilemma of providing care to such patients. These results contribute to growing evidence of the need for institutions to better support an increasingly diverse physician workforce with policies and specific guidance to help physicians respond to discrimination from patients while still providing quality care.
工作场所的歧视会对有色人种医生的个人和职业生活产生负面影响。尽管患者的歧视行为已经在社交媒体、大众媒体和个人随笔中可见，但针对患者作为针对有色人种医生的歧视来源的研究却很少。
探讨从事普通内科工作的医生观察或与表现出针对有色人种医生的歧视行为的患者互动的经历。
一项定性研究，采用 2019 年 5 月至 9 月间进行和记录的深入、半结构化、一对一电话访谈。
美国 12 家学术医疗中心的 24 名普通内科医生，他们有意参与了这项研究：14 名自认为是白人，10 名自认为是有色人种医生，其中包括亚裔、非裔、美国原住民和自认为其他种族的医生。
四位编码员分析了转录和验证的访谈文本；采用主题分析方法，对主题和子主题进行归纳分析。
分析结果揭示了四个主要主题：（1）认为一个合格的医生应该是白人、男性和身体健康的假设；（2）黑人经历的遗留问题；（3）努力克服歧视的挣扎；（4）为歧视性患者提供护理的道德困境。除了基于医生的种族或族裔的歧视外，参与者还描述了基于医生的性别和残疾状况的歧视经历或观察到的歧视。参与者普遍表示需要同事更多的支持和机构政策的更多指导。
在学术环境中工作的普通内科医生报告称，他们观察或经历过基于医生的种族、族裔、性别（或其交叉）和残疾状况的患者歧视，以及为这些患者提供护理的道德困境。这些结果为越来越多的证据表明，各机构需要通过政策和具体指导为日益多样化的医生队伍提供更好的支持，帮助医生应对来自患者的歧视，同时提供优质的护理。
