A majority of doctors (59%) say they confront bias from patients, including offensive remarks about gender, age, race, and ethnicity, according to a new survey. Four in ten (40%) take action to report it or address it, either by documenting the bias in a patient’s medical record or reporting it to an authority. In a companion survey, 11% of patients reported hearing offensive remarks from their healthcare professional.
The survey, Patient Prejudice: When Credentials Aren’t Enough, was conducted by WebMD/Medscape in collaboration with STAT, a Boston Globe Media publication. The survey of professionals presents findings from more than 1,000 healthcare professionals (HCPs), including doctors, registered nurses, nurse practitioners, and physician assistants. The survey of 1,000 patients asked about biases toward doctors and other healthcare professionals.
To read the full special report, Patient Prejudice, visit www.webmd.com/patientprejudice, http://www.medscape.com/patientprejudicereport2017, and https://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors/.
How Physicians Experience Bias: Comments Focus on the Physical
Nearly six in ten doctors (59%) say they experience bias most often related to their physical characteristics. Forty-seven percent report that a patient requested a different doctor based on their characteristics or background. The report also found that:
- African-American/Black (70%) and Asian (69%) doctors are more likely to report hearing biased remarks from patients than are white doctors (55%).
- Nearly two-thirds of female doctors (65%) experience bias versus men (55%).
- Female doctors are most likely to hear biased remarks regarding their appearance, including their age (36%) and weight (15%); age bias was particularly high for all doctors age 34 and younger (54%).
- Nurses are more likely to hear offensive comments about their weight (23% for registered nurses and 18% for nurse practitioners) than other healthcare professionals.
- Male doctors most often report hearing biased remarks about their ethnicity (24%) and age (23%). Men are also more likely to hear remarks about religious bias (15%) than women (8%).
- Bias was also reported to a lesser degree with respect to a doctor’s political views (11%) or sexual orientation (4%).
The survey found that nearly one-quarter (24%) of doctors have documented bias incidents in patient records, while 9% have refused to care for a patient who expressed bias toward them.
The Patient Side of Bias: Preferring Doctors More Like Themselves
Nearly one-third of patients (29%) admit they would be inclined to avoid a health care professional based on personal characteristics. When choosing a primary care doctor, women (28%) are more likely than men (12%) to say they prefer one who is the same gender as they are. The following were also cited by patients as preferred characteristics for their primary care doctor:
- Sexual orientation (11%)
- Ethnicity (8%)
- Religion (7%)
- Political views (6%)
- Race (5%)
More than 90% of patients responding to the survey said they had visited a health care professional within the past five years. Of those, 11% report having heard offensive remarks directed towards them from their healthcare provider. While the majority of those patients (58%) won’t take any action, 42% will. If they do move ahead to address it, their top actions are to change their HCP (26%) or confront him or her (15%). Thirteen percent say they are planning to change their HCP in the future.
Patients may also write a negative review of the HCP or file a formal complaint. Eleven percent of patients have written a negative review of a health care provider online as a result of hearing an offensive remark. Seven percent filed a formal complaint. That compares to 10% of healthcare professionals who say a patient has written a formal complaint about them because of a personal characteristic in the past five years.
“When either a patient or a physician brings prejudice into the healthcare setting, it can strain the doctor-patient relationship, even if the treatment is not impacted,” said Arefa Cassoobhoy, MD, MPH, Senior Medical Director for WebMD & Medscape. “Patients may be surprised to know that, according to the survey, not only do healthcare professionals notice bias, but they may document it in their chart.”
STAT conducted separate in-depth interviews with doctors around the U.S. that documented the lasting scars left by patients’ hurtful remarks. As one Pennsylvania physician told STAT senior writer Bob Tedeschi, “You come here and pour your blood, sweat, and tears for your patients, and then to have that stuff come up, absolutely it’ll lead to burnout.”
To learn more about bias in health care, visit www.webmd.com/patientprejudice.
Patient Survey Methods
WebMD’s survey was completed by 1,019 respondents from July 13 to July 17, 2017, using the NORC AmeriSpeak® Panel, a probability-based panel designed to be representative of the U.S. household population. The margin of error for a statistic at 50% is +/- 4.06% at the 95% confidence level, for the entire sample of 1,019 respondents. Statistics for subgroups of the sample have larger margins of error, as do statistics greater or less than 50%. Most questions in the survey were completed by a subgroup of 947 (934 weighted) respondents who had visited a healthcare provider in the past 5 years.
Funded and operated by NORC at the University of Chicago, AmeriSpeak is a probability-based panel designed to be representative of the U.S. household population. Randomly selected U.S. households are sampled with a known, non-zero probability of selection from the NORC National Sample Frame, and then contacted by U.S. mail, telephone, and field interviewers (face to face). AmeriSpeak panelists participate in NORC studies or studies conducted by NORC on behalf of governmental agencies, academic researchers, and media and commercial organizations. NORC at the University of Chicago is an independent research institution.
Professional Survey Methods
Survey invitations were emailed to Medscape members from July 17 through August 22, 2017. Medscape members who completed the survey were entered into a sweepstake that awarded 25 random winners a $100 Amazon gift card. African-American/Black and Hispanic Medscape member physicians were quotas sampled in order to obtain a larger subgroup size for analysis; they were then weighted to reflect the proportions of each in the Medscape member population. Respondents were required to be practicing U.S. physicians, registered nurses, nurse practitioners or physician assistants. The sample size was 1,186 health care providers, including 823 physicians, 100 registered nurses, 160 nurse practitioners and 104 physician assistants. The margin of error for this survey among physicians is +/- 3.42%; among registered nurses, +/- 9.8%; among nurse practitioners, +/- 7.75%, and among physician assistants, +/-9.61%, at the 95% confidence level for a statistic at 50%.
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