The Exchange

Commentary and Observations from
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Should We Accommodate Discriminatory Requests from Patients?

Should We Accommodate Discriminatory Requests from Patients?

As medical providers, we took an oath to provide the same quality of care to all our patients regardless of their race, gender, religion, sexual orientation, or nationality. Yet, this doesn't seem to go both ways. Granted, we can all recognize when perceived discriminatory requests are justified by intimate privacy concerns (eg, by sexual assault victims), religious beliefs, or cultural needs. What we should never accept or allow are discriminatory requests grounded in bigotry. In one example of this, a man in Michigan with a swastika tattoo instructed the neonatal intensive care unit that he didn't want a black nurse to touch his newborn baby. That hospital appeased him, and the nurse subsequently sued her employer for instituting racial bias.

Sometimes patients want to choose their medical provider based on certain traits they deem important to them, whether it be race, gender, or religious beliefs. In the outpatient setting, patients have all the information and freedom they need to select a provider based on any number of their biases. Within a hospital or health system, however, requesting that these biases be accommodated puts healthcare professionals and the institution at risk.

There's another important reason that medical facilities shouldn't have policies or practices that accommodate these requests: it can, and will, cause measurable moral distress to their providers. Providers find these requests painful and degrading and by perpetuating and accentuating the bigotry, institutions exacerbate feelings of betrayal and violation among their clinicians.

So how should an instance of patient bias be dealt with? Clinicians should start by informing patients that they cannot indulge these requests, and hospital personnel should do their best to mitigate such requestsperhaps by assuring the patient that the clinician in question is highly qualified in their field and capable of providing a high standard of care. Sometimes a patient will not be swayed by these points and will remain adamant about their discriminatory requests. In these cases, patients should be informed that it is within their patient rights to seek care from a different clinician and practice.

Another way to deal with patient bias is a bottom-up approach where, in order to avoid a discriminatory patient, a clinician voluntarily reassigns care. This approach enables providers to determine the outcome instead of a healthcare practice imposing provider reassignment. It is motivated by the clinician's desires to avoid the patient rather than the desire to cater to biased requests.

While we certainly should not condone accommodating racist patients, it is important to keep in mind that doing so may improve health outcomes. Research has shown that when patients and providers share the same race, patients report "longer visits, more effective communication, more participatory decision-making, and greater overall satisfaction." This may be due to shared cultural understandings and a stronger feeling of trust by the patient. Additionally, prejudice is a two-way street, and providers are just as likely as patients to be influenced by their own implicit biases, perhaps unintentionally impacting the patient's overall visit.

Effective patient-provider relationships are dependent on trust, productive communication, mutual respect, and cooperation. The patient must feel confident that the provider will act in their best interest, and the provider will likely perform better if spared the stress of caring for a prejudiced patient.


Filed under: Health Policy and Trends, NPs & PAs, Practice Management/Career

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