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Invited Commentary
October 28, 2019

Confronting Bias and Discrimination in Health Care—When Silence Is Not Golden

Author Affiliations
  • 1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
  • 3Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland
  • 4Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 5Department of African and African American Studies, Harvard University, Cambridge, Massachusetts
JAMA Intern Med. 2019;179(12):1686-1687. doi:10.1001/jamainternmed.2019.4100

In this issue of JAMA Internal Medicine, Wheeler et al1 report results from a novel qualitative study in which the investigators examined how physicians and trainees perceive, react, and respond to incidents of biased patient behavior. Study participants reported varied experiences with discriminatory patient behavior, ranging from mildly disparaging comments to openly racist, sexist, or homophobic stereotyping remarks and absolute refusals of care. They also described myriad reactions to these situations, including pain, fear, anger, and confusion. Barriers to appropriate responses included a lack of skills in confronting patients exhibiting biased behavior, lack of support from colleagues and guidance from the institution, and uncertainty about whether responding to these experiences would be perceived as unprofessional. This study provides insights into the gravity of the problem of discriminatory patient behavior, raises key unanswered questions, and calls for action from the medical profession.

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    1 Comment for this article
    Implicit Male Patient Bias/ Discrimination
    R Rozak, MA | University Education
    Does bias or discrimination in health care include bias or discrimination towards  the male patient? Is the male patient’s request for all-male care respected with the same urgency as that of a female patient requesting all-female care? Are male patients afforded the same dignity regarding bodily exposure as female patients? Is there evidence-based criterion for having female nurses for male urology but, absolutely no males in mammography? Why are these issues not addressed as correlates to bias and discrimination in health care?