Addressing Patient Bias and Discrimination Against Clinicians of Diverse Backgrounds

Physicians on the move: practices for shaping a professional medical persona in a second language

BACKGROUND

Numerous healthcare studies emphasize the impact of linguistic background on physician-patient communication. Cultivating a credible professional image through proficient communication skills is essential for promoting patient compliance and achieving positive treatment outcomes. Language proficiency influences a physician's sense of self and ability to provide quality healthcare. This study aimed to explore the practices used by physicians trained in their country of birth to develop a trustworthy professional identity in a second language.

METHOD

The data included transcripts from video-recorded consultations (n = 40, total duration t∼22.5 h) conducted in Norwegian outpatient clinics (n = 6). These consultations involved interactions between Polish physicians (n = 8) and Norwegian patients. Using observational and qualitative analyses, the study focused on identifying recurrent phenomena in the physicians' utterances. To contextualize the findings, qualitative analysis was conducted with the Corpus of Doctor-Patient Conversations from Akershus University Hospital (Ahus). Additionally, insights were obtained from audio-recorded interviews with two participating physicians and two other Polish physicians practicing in France. The data sets complemented each other to demonstrate the generalizability of key communication aspects that physicians should consider when using second-language skills with patients and colleagues.

RESULTS AND CONCLUSIONS

Foreign physicians employ various practices to address the diverse and intricate aspects of medical conversations. Establishing a professional stance involves steering the consultation, highlighting one's expertise and humor, and incorporating explanations from the native language. Effective communication is achieved through the substitution of medical terminology with everyday words as well as the use of figurative language, paraphrasing, and repetition.

Understanding the experience of Latinas in medical education: A qualitative study

BACKGROUND

Despite increased recruitment of Latina medical students, the percentage of Latina physicians has remained stagnant, suggesting unique retentive barriers affecting this population. Discriminatory experiences involving bias may contribute to difficulties in the retention and advancement of Latinas in medicine. This qualitative analysis aimed to explore thematic barriers prevalent among Latinas throughout their medical training in the United States.

METHODS

An anonymous online survey was distributed to Latinas in the continental United States from June 22 to August 12, 2022. Eligibility criteria included self-identifying as Hispanic/Latina, female/woman, and being currently enrolled in or graduated from medical school, residency, or fellowship in the United States in the past 10 years. Content and thematic analyses were done on 602 responses across seven open-ended survey questions.

RESULTS

Data were categorized into three main themes: (1) barriers stemming from limited social, cultural, and financial capital; (2) experiences of discrimination, bias, and perceptions of being undervalued; and (3) burdens resulting in notable mental health challenges such as depression and anxiety. Many women questioned their place in medicine throughout training and the value of the sacrifice and trauma endured.

CONCLUSION

This is the first qualitative study evaluating the experiences of Latinas throughout medical training, revealing that they experience disproportionate barriers and discriminatory experiences from both colleagues and patients. Despite calls to enhance institutional climates of diversity, there continues to be an acute need for the reform of medical education to promote an inclusive culture and provide adequate mentorship to marginalized trainees.

Latinas in medicine: evaluating and understanding the experience of Latinas in medical education: a cross sectional survey

BACKGROUND

The percentage of physicians identifying as Latina has not improved despite improvements in recruitment of Latina medical students, suggesting barriers to retention and career advancement. Discriminatory experiences and mental health inflictions throughout training may contribute to difficulties in recruitment, retainment, and advancement of Hispanic/Latinx trainees, a notably understudied population.

METHODS

An anonymous, online survey was distributed to Latinas in the continental U.S. between June 22 to August 12, 2022. Eligibility criteria included: self-identifying as Hispanic/Latina, female/woman, and completing or have completed medical school, residency, or fellowship in the continental U.S. in the past 10 years. Recruitment was done via the Twitter account @LatinasInMed and outreach to Latino Medical Student Association chapters. Descriptive statistics summarized the self-reported experiences.

RESULTS

The survey included 230 Hispanic/Latinx women, mostly medical students (46.9%). A majority (54.5%) reported negative ethnicity-based interactions from patients and/or patients' families; 71.8%, from others in the medical field. High rates of depression (76.2%) and anxiety (92.6%) during training were reported by Latinas, especially medical students. Feelings of imposter syndrome and burnout were high at 90.7% and 87.4%, respectively.

CONCLUSIONS

This is the first study evaluating the unique experiences of Latinas in medicine, who reported discrimination and mental health struggles, specifically during medical school, at alarmingly high rates. Our findings could aid in creating the needed interventions to support Latinas in medical training to reduce the existing exodus of Latinas from medicine.

Does racism toward nurses increase as treatment invasiveness rises?

One of the unspoken issues in public discourse in most countries is the racism of patients toward nurses who originate from a different ethnic group than theirs. The aim of the present study is to examine whether patients' racism toward nurses increases as the invasiveness of treatment rises. This study was conducted in Israel, a highly conflictual society where Jews and Arabs live together and meet in the same health facilities. Despite the tension and sometimes animosity caused by the political situation, members of each group regularly encounter members of the other group during the provision of health-care, both as patients and as medical and nursing staff. A study questionnaire which presented nine nursing treatments of diverse levels of invasiveness was filled out by Arab and Jewish participants. They were asked to convey their preference for an Arab or a Jewish nurse for each treatment. Results of Logistic Regression Analyses reveal that in both sectors, racism toward nurses increases as the treatment invasiveness rises. These findings are discussed in light of the concept of social distance, and serve as an empirical basis for several proposed practical recommendations for eradicating racism against nurses.

Racial Discrimination in Patient Care-Preserving Relationships With Integrity

The following case study describes what is known as the health care system's open secret of allowing a patient or family to refuse care from a clinician of another race. This article explores the ethical tension between autonomy, nonmaleficence, justice, and duty to treat as it relates to racism and the potential harm to clinicians, health care teams, and organizations. When racism is experienced within the clinical setting, clinician knowledge, organizational training, and moral character are essential for identifying and addressing it effectively. Racial discrimination and related mistreatment are not part of a responsive and proactive moral community. This article explores creative solutions that preserve patient-clinician relationships without sacrificing personal integrity when racism is encountered.

Looking through racism in the nurse-patient relationship from the lens of culturally congruent care: A scoping review

AIM

This review aimed to identify the nature of racism in the nurse-patient relationship and summarize international research findings about it.

DESIGN

A scoping review of the international literature.

DATA SOURCES

The search process encompassed three main online databases of PubMed (including MEDLINE), Scopus and Embase, from 2009 until 2021.

REVIEW METHODS

The scoping review was informed by the Levac et al.'s framework to map the research phenomenon and summarize current empirical research findings. Also, the review findings were reflected in the three-dimensional puzzle model of culturally congruent care in the discussion section.

RESULTS

The search process led to retrieving 149 articles, of which 10 studies were entered into data analysis and reporting results. They had variations in the research methodology and the context of the nurse-patient relationship. The thematical analysis of the studies' findings led to the development of three categories as follows: bilateral ignition of racism, hidden and manifest consequences of racism and encountering strategies.

CONCLUSION

Racism threatens patients' and nurses' dignity in the healthcare system. There is a need to develop a framework of action based on the principles of culturally congruent care to eradicate racism from the nurse-patient relationship in the globalized context of healthcare.

IMPACT

Racism in the nurse-patient relationship has remained a relatively unexplored area of the nursing literature. It hinders efforts to meet patients' and families' needs and increases their dissatisfaction with nursing care. Also, racism from patients towards nurses causes emotional trauma and enhances job-related stress among nurses. Further research should be conducted on this culturally variant phenomenon. Also, the participation of patients and nurses should be sought to prohibit racism in healthcare settings.

Addressing Mistreatment by Patients in Geriatric Subspecialties: A New Framework

Mistreatment by patients is unfortunately common in clinical medicine, including geriatric subspecialties. Despite the prevalence of this problem, there are few standardized approaches for addressing it at both interpersonal and institutional levels. The "ERASE" framework is a novel, practical approach for addressing mistreatment by patients. "ERASE" includes Expecting and preparing for mistreatment by patients, Recognizing mistreatment, Addressing mistreatment in real time, Supporting members of the healthcare team who have been mistreated, and Establishing a positive institutional culture. The framework may prove particularly helpful and applicable to providers specializing in geriatrics and can be used by administrators, educators, and all members of the healthcare team to promote safe, dignified clinical care and learning environments.

Strategies to Reduce Bias and Racism in Nursing Precepted Clinical Experiences

BACKGROUND

Nursing programs are tasked with ensuring diverse, equitable, and inclusive (DEI) learning environments for all student learners. With calls to diversify the nursing workforce, engaging nursing preceptors in program-wide DEI initiatives are crucial. Preceptors lacking commitment to DEI could result in poor patient-preceptor communication, tense learning environments, or biased evaluations of students.

METHOD

Suggestions for successful strategies to include the preceptor in nursing program's antiracism initiatives are based on the current literature.

RESULTS

Best practices include providing antiracism training for preceptors, decreasing potential for bias in student evaluations, inquiring about observed racism in clinical sites, and equipping students to be upstanders for antiracism and DEI interventions.

CONCLUSION

Dismantling racism and bias in nursing education requires a multilevel strategy. Nursing programs and nurse educators have a responsibility for ensuring a bias-free learning environment and should include the preceptor in antiracism strategic planning. [J Nurs Educ. 2021;60(12):697-702.].

Examining clinical training through a bicultural lens: Experiences of genetic counseling students who identify with a racial or ethnic minority group

Biculturals are individuals who have had significant exposure to more than one culture and who possess more than one cultural frame of reference. In the United States, this term has been used to describe both immigrants and members of racial or ethnic minority groups who live within the majority white culture. Biculturals develop a distinct repertoire of social and cognitive skills and have been shown to engage in a process of cultural frame switching in response to salient cultural cues. Through a conceptual lens offered by current research on biculturalism, this article examines transcripts of focus groups we collected for a study on the clinical training experiences of genetic counseling students who identify with a racial or ethnic minority group. We conducted a constructivist grounded theory study, collecting data via 13 videoconference focus groups with 32 recent graduates of genetic counseling training programs who identify with a racial or ethnic minority group. We focus here on two of the thematic categories identified in that study related to participants’ experiences interacting with patients during supervised clinical rotations. We find three ways in which being bicultural influenced these genetic counselors’ patient interactions. First, participants described interactions with both culturally concordant and culturally discordant patients that highlighted the salience of their racial, ethnic, or cultural identity in these encounters. Second, they reported sensitivity to social nuances between and within cultures, reflecting the findings of prior research about heightened cultural awareness in biculturals. Third, they described switching cultural frames in response to their patients’ identities which, at times, created conflict between their professional and culturally concordant frameworks. The results of this study suggest that the influence of a student's racial, ethnic, or cultural identity on interactions with patients should be discussed within the supervisory relationship, and that being bicultural confers advantages in learning to provide culturally responsive care.

Patient and provider factors associated with receipt and delivery of brief interventions for unhealthy alcohol use in primary care

BACKGROUND

Unhealthy alcohol use is a serious and costly public health problem. Alcohol screening and brief interventions are effective in reducing unhealthy alcohol consumption. However, rates of receipt and delivery of brief interventions vary significantly across healthcare settings, and relatively little is known about the associated patient and provider factors.

METHODS

This study examines patient and provider factors associated with the receipt of brief interventions for unhealthy alcohol use in an integrated healthcare system, based on documented brief interventions in the electronic health record. Using multilevel logistic regression models, we retrospectively analyzed 287,551 adult primary care patients (and their 2952 providers) who screened positive for unhealthy drinking between 2014 and 2017.

RESULTS

We found lower odds of receiving a brief intervention among patients exceeding daily or weekly drinking limits (vs. exceeding both limits), females, older age groups, those with higher medical complexity, and those already diagnosed with alcohol use disorders. Patients with other unhealthy lifestyle activities (e.g., smoking, no/insufficient exercise) were more likely to receive a brief intervention. We also found that female providers and those with longer tenure in the health system were more likely to deliver brief interventions.

CONCLUSIONS

These findings point to characteristics that can be targeted to improve universal receipt of brief intervention.

The impact of racism on emergency health care workers

INTRODUCTION

Discrimination based on race is a known source of stress in individuals and is a contributor to poor health outcomes in patients. However, less is known about how the experiences of racism impact the stress levels of emergency health care workers (EHCWs).

OBJECTIVES

The goal of this study was to assess the impact that racism has on the stress of EHCWs.

METHODS

An anonymous electronic cross-sectional survey of EHCWs including attending physicians, resident physicians, advanced practice providers, nurses, and staff at three large metropolitan hospitals was administered in the summer of 2020. The survey evaluated the stress related to systemic racism and the COVID-19 pandemic in addition to the wellness measures utilized to cope with these stressors. The focus of this article is the impact of systemic racism on EHCWs.

RESULTS

Of the 576 eligible participants, the total number of respondents utilized for analysis was 260. Overall, 64% of participants were very concerned about the state of racism in the United States, and 30% reported moderate-high or high stress resulting from racism. When stratified by race, 46% of Black participants reported moderate-high or high stress resulting from racism, compared to 31% of other participants of color and 23% of White participants (p = 0.002).

CONCLUSION

Systemic racism is a significant concern and source of stress for EHCWs. Additional research about systemic racism, its impact on medical providers, and more importantly, active strategies to reduce and ultimately eliminate it in health care is needed.