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Teachable Moment
Physician Work Environment and Well-Being
October 4, 2021

Addressing Biased Patient Behavior: A Teachable Moment

Author Affiliations
  • 1Department of Internal Medicine, University of Michigan, Ann Arbor
  • 2Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
JAMA Intern Med. 2021;181(12):1631-1632. doi:10.1001/jamainternmed.2021.5719

A patient was admitted to a medicine service for treatment of newly diagnosed cancer. The team caring for the patient comprised a medical student, intern, senior resident, and attending physician.

During bedside teaching rounds, the student reviewed the treatment plan. The patient thanked her for the update and complimented her appearance. Sensing boundary violations, the attending physician requested the patient keep the conversation professional and restated the role of the medical student. The encounter continued and the patient referred to all team members professionally thereafter.

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3 Comments for this article
Another common bias
Ronald Hellman, MD, MS | Former Associate Professor of Psychiatry, Ichan School of Medicine at Sinai, New York
In addition to age, race, sex, and ethnicity, sexual and gender orientations are known to elicit bias from patients.
More detail on the offense.
Justin Starren, MD, PhD | Northwestern University, Feinberg School of Medicine
Simply stating that the patient complemented the medical student on her appearance is quite vague. In many elderly patients, this can be part of the routine greeting, as in "you look nice today". On the other hand, it can also be phrased in a way that is clearly diminishing, sexual, and is a power gesture.

The reader is left to infer that the latter occurred based in the attending's reaction, but we are still guessing.

A little more detail on what the patient said would make the teaching lesson both clearer and more
Medical Students and Difficult Patient Encounters
Hojin Seo, Medical Student | Rocky Vista University
As a medical student who is starting her rotations in a few months, I find myself thinking every now and then about how to manage a doctor-patient relationship when a patient makes inappropriate comments. My initial instinct would be to laugh uncomfortably and try my best to brush it off, hoping that I do not disrupt the dynamic of the medical team I am working with. If I felt that a comment was too inappropriate, I would try to banter with the patient in the hopes that I don’t offend them directly. However, over time, I could see how continually brushing off inappropriate comments may lead to a decreased sense of competence and self-worth. Additionally, ignoring inappropriate comments may negatively affect the care I provide (given that I already don’t think of the patient in high regard), and bantering with the patient would not address the gravity of the situation.

Oftentimes as students, we are so hyper-focused on doing well on our rotations, that we may allow for certain inappropriate behaviors to slide, so our grades won’t be compromised. As a result, it is very refreshing to hear of attendings who take the time to address biased patient behavior in order to ensure the well-being of their medical trainees. I thank the authors for writing about a topic that needs to be continually addressed in medical education.