How to Spot and Tactfully Handle Discrimination in the Health Care Setting
In the moment, it can be difficult to respond effectively, but practicing these four skills and tactics can help.
Fam Pract Manag. 2021 Sep-Oct;28(5):21-24.
Author disclosures: no relevant financial affiliations.
Over the past several years, overdue conversations about implicit bias in medicine and the need for health equity have emerged, and workplaces are increasingly developing strategies to address the problem. PubMed searches of the terms “implicit bias” and “health equity” reveal that the number of articles published on this topic has increased exponentially over the last decade. Health care workers are talking about and working on these issues now more than ever. As awareness grows, many professionals are looking for tools and techniques to unlearn harmful thought processes, correct common misperceptions, and address bias when it arises.
Workforce diversity in medicine is a public health issue. Research shows that physicians from Black, Hispanic, and Asian backgrounds play a critical role in providing care to underserved patient populations.1 The physician workforce in the U.S. is becoming more diverse, but it is still predominantly white and male.2 Those with different identities can often feel that they are on the outside, and the constant struggle to belong or be included can feel exhausting. Representation matters because it enables those with non-dominant identities to see others like them in medicine and recognize that they, too, belong.
Making medical education more accessible to those from underrepresented groups is a key step, but physicians continue to face bias in their work environments throughout their training and career.
This article aims to equip physicians with four skills and tactics to spot and tactfully handle discrimination in the health care setting.
All too often, discriminatory behaviors go unaddressed because we either fail to recognize them or feel unable to respond.
One tactic for addressing discrimination is the concept of “calling in” versus “calling out”; instead of attacking someone for their behavior, start from a place of curiosity and assume good intent.
While it is natural to want a checklist or concrete guidelines for handling these situations, the reality is that this is messy work.
FOUR SKILLS AND TACTICS
Think about a time when you witnessed discrimination in a health care setting, whether toward yourself or someone else. It might have involved a hurtful and unjust interaction with a patient or a colleague based on age, race, gender, ethnicity, religion, sexual orientation, body type, physical or mental ability, education, language, etc. Reflect on how you handled (or didn't handle) the situation, and how challenging it might have been.
All too often, discriminatory behaviors go unaddressed because we either fail to recognize them or feel unable to respond, like a deer caught in the headlights. In the moment, it can be difficult to come up with the right response — something to say or do. Practicing the following skills and tactics can
1. Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority physicians' role in the care of underserved patients: diversifying the physician workforce may be key in addressing health disparities. JAMA Intern Med. 2014;174(2):289–291.
2. Association of American Medical Colleges. Diversity in medicine: facts and figures 2019. Accessed July 27, 2021. https://www.aamc.org/system/files/2019-12/19-222-Executive%20Summary-FINAL-120919.pdf
3. Holm AL, Rowe Gorosh M, Brady M, White-Perkins D. Recognizing privilege and bias: an interactive exercise to expand health care providers' personal awareness. Acad Med. 2017;92(3):360–364.
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