How should doctors respond to racist and sexist remarks from patients?


By David Rowley

23 Apr 2019

While cases of sexual harassment by doctors on doctors are often the stuff of newspaper headlines, doctors facing harassment and discrimination from patients seldom get the same attention.

And US doctors say healthcare professionals are getting little support or advice on how to respond to inappropriate behaviour or comments from patients while maintaining a professional doctor-patient relationship.

Writing in the  American Journal of Medicine they note that doctors have a right to be free from workplace discrimination, and yet codes of conduct provide little practical guidance on how to handle incidents of harassment without denying patients access to care they may need. Clinicians need to undertake a tricky balancing act of both showing empathy for the patient’s clinical concerns while also setting “clear and explicit boundaries” should a problem arise, they suggest.

They cite the example of a patient commenting on the ‘attractive appearance’ of a female physician while doing her rounds.

“The patient’s comment angers and offends the physician and in her surprise, she is not sure what to say or do next,” they write.

“She is anxious to respond professionally, but quickly realises she is unsure how to address the comment without embarrassing the patient or undermining the treatment alliance”.

The authors advise against unproductive  ‘retaliatory’ responses such as describing something as ‘racist’, and to instead focus on non-judgemental terms such as “potentially discriminatory”.

“When confronted with the comment, she could pause and say, ‘Your comments about my appearance make me uncomfortable. I wonder if you think you have to compliment me to get good care. For now, I want to focus on your healthcare. Please tell us how you’re feeling and how we can help’.”

In some cases sexual harassment or discrimination could be blatant, other times more subtle and, in some cases could be based on the patient diminished responsibility such as with neurocognitive impairment, they said.

While recognising an illness may be contributing to the behaviour, excusing or tolerating it would be “ironically paternalistic” if it failed to hold the patient responsible, they suggested.

“Communication in psychologically challenging situations benefits from a prepared and structured response that can reduce stress and improve performance. Scripts are both teachable and learnable and allow a professional to draw upon a practiced response especially when their own cognitive resources are limited due to strong emotions,” they wrote.

Associate Professor Adrienne Torda, Senior Staff Specialist at the Dept of Infectious Diseases, Prince of Wales Hospital and Gender Champion for UNSW Sydney said female doctors dealt with the issue even more poorly than in dealing with sexism from colleagues.

While she believes some female doctors would now call out sexism from colleagues “it is much harder with patients,” she told the limbic.

“We would rather just work around it, than address it, much of the time,” she said.

“The dynamic is really difficult because often these patients are elderly, vulnerable and we do care more about their care than our feelings”.

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