A Black nurse at a Pennsylvania hospital reported that her emergency room colleagues routinely withheld pain medication from Black patients suffering from sickle cell disease.
In Montana, a phlebotomist reported that fellow healthcare workers frequently made “ignorant comments” about the hospital’s Native American patients.
Both of these accounts appeared in a report released this week by the Commonwealth Fund and the African American Research Collaborative, which was based on interviews with thousands of workers who shared their experiences at hospitals and health facilities on the condition that their identities not be revealed in the groups’ findings. Researchers surveyed 3,000 health care workers in what the authors described as a first-of-its-kind attempt to quantify whether employees perceive discrimination in the workplace. Hospitals, nursing homes, outpatient care (such as urgent care centers), mental health and addiction treatment centers, and community or school health centers were the five types of health facilities.
Nearly half of the health-care workers at these facilities reported encountering patient discrimination in the workplace. Younger and Black or Latino health care workers were more likely than their older or white counterparts to report discrimination against patients.
Among the survey’s key findings: 47% of U.S. health care workers reported witnessing discrimination against patients, and 52% said racism against patients was a major issue. Furthermore, employees at health facilities with a higher percentage of Black or Latino patients reported higher levels of discrimination. At hospitals with a high proportion of Black patients, 70% of employees reported witnessing discrimination against patients based on their race or ethnicity. That figure was 61% in hospitals with a predominantly Latino patient population.
According to Dr. Laurie Zephyrin, senior vice president for advancing health equity at the Commonwealth Fund and co-author of the report, the findings show that patient discrimination is a problem.
“It is something that needs to be addressed,” Zephyrin stated. “It affects both patients and healthcare workers. “It causes stress.”
Doctors who were not involved in the report emphasized the importance of quantifying discrimination in health-care settings.
Yolanda Lawson, a Dallas obstetrics and gynecology specialist, is the president of the National Medical Association, which represents Black doctors. She stated that the report validates what many physicians and other health care workers already know to be true: discrimination and bias exist in healthcare settings.
“It’s important to quantify it and put it in a more credible format,” Lawson went on to say. including “many physicians and health care workers of color, it’s not uncommon for us to recognize it or call it out.”
Younger workers are more likely to recognize discrimination.
The phone and online survey was conducted between March 14 and April 5, 2023. It solicited responses from over two dozen different types of health care workers, including doctors, nurses, licensed practical nurses, dentists, medical assistants, dental hygienists, physician assistants, mental health workers, and administrators.
According to Henry Fernandez, CEO of African American Research, the survey “oversampled” Black, Latino, Asian, and Pacific Islander health care workers to ensure a large enough sample size and a smaller margin of error.
Among other findings, the report’s authors noted a significant generational divide among health care workers, with 59% of workers under 40 experiencing stress as a result of discrimination, compared to 26% of workers over 60. Younger employees were more aware of discrimination or more likely to notice signs of it.
According to Zephyrin, discrimination is a “critical area to address” in order to attract and retain employees during a widespread shortage of health care workers.
Fernandez stated that the likelihood of younger workers noticing discrimination against patients was “one thing that really stood out for me.”
He described it as a critical area of focus, particularly as the health-care industry hires and trains young workers to address chronic workforce shortages.
The report proposed several solutions to combat discrimination in health care, including training medical staff to recognize discrimination and mandating discrimination classes in nursing, medical, and other health schools. Another suggestion: develop a system for patients and health-care workers to anonymously report discrimination. The report suggested that health care systems take on this responsibility in order to encourage employees and patients to report instances of discrimination and racism while protecting the complainant’s identity.
Hospitals and other facilities should also consider how they treat non-English speakers. According to the report, Latino health workers claim that patients who do not speak English are not always treated equally.
A lesson about respect
Another study finding that has struck a chord with many people is that nearly half of the health workers polled believe their colleagues are more accepting of white patients when they advocate for their care than of black patients. According to the report, 48% of health-care workers reported disparities in treatment for patients who advocated for themselves.
Zephyrin expressed concern that patients who advocate for themselves are treated differently. In an ideal situation, patients should be encouraged to ask questions and notify a supervisor if a doctor or nurse isn’t meeting their needs, Zephyrin said.
However, the report suggests that when patients try to advocate for themselves, they may be treated differently depending on their race.
Lawson, the Dallas specialist, stated that during her third year of medical school, she observed how some doctors talked over patients and failed to listen to their concerns. She studied at a Veterans Administration hospital alongside other medical students, young doctors, and a teaching physician.
The doctor who was instructing the medical students and resident doctors described the care provided to an elderly Black veteran at his bedside. The veteran was perplexed by what the doctors were saying, and no one took the time to explain anything to him, Lawson recalled.
As the group of resident doctors and medical students rounded to the next patient, the man extended his hand to Lawson, the only Black person in the group.
“He asked, ‘What did they say?'” Lawson said.
She described the man’s X-ray results and other aspects of his treatment for several chronic conditions. It is a lesson she has retained and applied throughout her professional career, and one she teaches to young doctors.
“You speak to the patient. “You include them in their care,” Lawson explained. “That’s all I really hope for, (that) everyone who interfaces with the health care system is respected.”
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