Hospitals should enact concrete protocols to help health care workers cope with patients who express bias based on characteristics like race, ethnicity, gender, sexual orientation, or religion, according to a study published in the AMA Journal of Ethics. These patients pose an ethical dilemma and challenge the ability of clinicians and other allied health care workers to balance their duty to provide high-quality care with their obligation to not treat a patient against their wishes.

Five protocols are outlined to address the problem of patients’ discriminatory behavior toward health care workers, especially vulnerable frontline staff like trainees who interface with patients more frequently than attending physicians and lack decision-making autonomy. These protocols include assessment, debriefing, team meetings, tracking and data collection, and organizational cultural change.

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Assessment involves a supervisor acknowledging a patient’s impropriety and intervening to inform the patient that the health care worker is qualified and that such behavior will not be tolerated. Following the event, debriefing with the affected worker is recommended to provide the worker the opportunity to express their experience, which helps them modulate emotional, neural, and autonomic responses. Convening a team meeting is another platform for workers to share their experiences with these patients and discuss how to address and diffuse these situations, which is valuable for onlookers or other clinical team members who may not know how to respond.

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Tracking and collecting data on each incidence of bias is necessary to understand the frequency of these events, the effect on the targeted health care worker, the organization’s response, and the ultimate resolution of these events. This step can provide a systematic understanding of these incidents and in which departments they typically occur, highlighting patterns of behavior and conduct that require a cultural change. To effect organizational cultural change, however, hospital administration must emphasize the importance of reporting each incident of bias while also fostering a culture that supports health care workers who have experienced discrimination.


Paul-Emile K. How should organizations support trainees in the face of patient bias? AMA J Ethics. 2019;21(6):e513-e520.