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Resident Physician Experiences With and Responses to Biased Patients.

Publication ,  Journal Article
de Bourmont, SS; Burra, A; Nouri, SS; El-Farra, N; Mohottige, D; Sloan, C; Schaeffer, S; Friedman, J; Fernandez, A
Published in: JAMA Netw Open
November 2, 2020

IMPORTANCE: Biased patient behavior negatively impacts resident well-being. Data on the prevalence and frequency of these encounters are lacking and are needed to guide the creation of institutional trainings and policies to support trainees. OBJECTIVE: To evaluate the frequency of resident experiences with and responses to a range of biased patient behaviors. DESIGN, SETTING, AND PARTICIPANTS: A retrospective survey was sent via email to 331 second- and third-year internal medicine residents from 3 academic medical centers in California and North Carolina. First-year residents were excluded owing to their limited interactions with patients at the time of participant recruitment. Data were collected from August 21 to November 25, 2019. MAIN OUTCOMES AND MEASURES: Descriptive statistics were used to report the frequency of experience of various types of biased patient behavior, residents' responses, the factors impeding residents' responses, and residents' experiences and beliefs regarding training and policies. RESULTS: Overall, 232 of 331 residents (70%) participated; 116 (50%) were women; 116 of 247 (47%) were White (participants had the option of selecting >1 race/ethnicity); and 23 (10%) identified as lesbian, gay, bisexual, transgender, or queer. The frequency of resident-reported experience of types of biased patient behaviors varied. The most common behaviors-belittling comments and assumption of nonphysician status-were reported to be experienced 1 or more times per week by 14% of residents (32 of 231) and 17% of residents (38 of 230), respectively. Women, Black or Latinx, and Asian residents reported experiencing biased behavior more frequently. Forty-five percent of Black or Latinx residents (17 of 38) encountered instances of explicit epithets or rejection of care. All 70 Asian residents reported experiencing inquiries into their ethnic origins. Most women residents (110 of 115 [96%]) experienced role questioning behaviors, and 87% (100 of 115) experienced sexual harassment. The need to prioritize clinical care and a sense of futility in responding were the most common factors (cited by 34% of residents [76 of 227] and 25% of residents [56 of 227], respectively) significantly impeding responses to biased behaviors. Eighty-five percent of residents (191 of 226) never reported incidents to their institution. Eighty-nine percent of residents (206 of 232) identified training and policies as necessary or very necessary. CONCLUSIONS AND RELEVANCE: This survey study suggests that biased patient behavior is experienced frequently by internal medicine residents. Non-White and women residents reported experiencing a disproportionate burden of these incidents. Residents' responses rarely included institutional involvement. Residency programs and health care systems should prioritize training and policies to address biased patient behavior and support affected residents.

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Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

November 2, 2020

Volume

3

Issue

11

Start / End Page

e2021769

Location

United States

Related Subject Headings

  • Sexual Harassment
  • Retrospective Studies
  • Prejudice
  • Physicians
  • Physician-Patient Relations
  • North Carolina
  • Middle Aged
  • Male
  • Internship and Residency
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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de Bourmont, S. S., Burra, A., Nouri, S. S., El-Farra, N., Mohottige, D., Sloan, C., … Fernandez, A. (2020). Resident Physician Experiences With and Responses to Biased Patients. JAMA Netw Open, 3(11), e2021769. https://doi.org/10.1001/jamanetworkopen.2020.21769
Bourmont, Shalila S. de, Arun Burra, Sarah S. Nouri, Neveen El-Farra, Dinushika Mohottige, Caroline Sloan, Sarah Schaeffer, Jodi Friedman, and Alicia Fernandez. “Resident Physician Experiences With and Responses to Biased Patients.JAMA Netw Open 3, no. 11 (November 2, 2020): e2021769. https://doi.org/10.1001/jamanetworkopen.2020.21769.
de Bourmont SS, Burra A, Nouri SS, El-Farra N, Mohottige D, Sloan C, et al. Resident Physician Experiences With and Responses to Biased Patients. JAMA Netw Open. 2020 Nov 2;3(11):e2021769.
de Bourmont, Shalila S., et al. “Resident Physician Experiences With and Responses to Biased Patients.JAMA Netw Open, vol. 3, no. 11, Nov. 2020, p. e2021769. Pubmed, doi:10.1001/jamanetworkopen.2020.21769.
de Bourmont SS, Burra A, Nouri SS, El-Farra N, Mohottige D, Sloan C, Schaeffer S, Friedman J, Fernandez A. Resident Physician Experiences With and Responses to Biased Patients. JAMA Netw Open. 2020 Nov 2;3(11):e2021769.

Published In

JAMA Netw Open

DOI

EISSN

2574-3805

Publication Date

November 2, 2020

Volume

3

Issue

11

Start / End Page

e2021769

Location

United States

Related Subject Headings

  • Sexual Harassment
  • Retrospective Studies
  • Prejudice
  • Physicians
  • Physician-Patient Relations
  • North Carolina
  • Middle Aged
  • Male
  • Internship and Residency
  • Humans