At a Pennsylvania hospital, a Black nurse said her emergency room colleagues routinely withheld painkillers from Black patients who sought relief for sickle cell disease.
A phlebotomist in Montana said fellow health care workers often make “ignorant comments” about Native patients in his hospital.
All of these accounts were revealed in a report released this week by the Commonwealth Fund and the African American Research Collaborative. The report is based on interviews with thousands of workers who shared their experiences in hospitals and health care facilities, but did not want to be identified in the organization's findings. Researchers conducted a survey of 3,000 healthcare workers, which the authors say is the first attempt to quantify whether employees perceive discrimination in the workplace. There is. His five categories of medical facilities include hospitals, nursing homes, outpatient services such as urgent care centers, mental health and addiction treatment centers, and community or school health centers.
Almost half of health care workers in these facilities witnessed discrimination against patients in the workplace. Younger and Black or Latino health care workers were more likely than older or white health care workers to say they noticed discrimination against patients.
Key findings from the survey included: 47% of U.S. healthcare workers said they had witnessed discrimination against patients, and 52% said racism against patients was a major problem. Additionally, employees at health care facilities with a higher proportion of Black or Latino patients witnessed higher rates of discrimination. At hospitals with a majority of black patients, 70% of employees said they had witnessed discrimination against patients based on their race or ethnicity. In hospitals with mostly Latino patients, that number was 61%.
The report's findings show that discrimination against patients is a problem, said Dr. Laurie Zephirin, senior vice president for health equity at the Commonwealth Fund, a co-author of the report.
“This is an issue that needs to be addressed,” Zephirin said. “This affects not only patients but also health care workers and creates stress.”
Doctors not involved in the report said efforts to quantify discrimination in medical settings are important.
Yolanda Lawson, a Dallas obstetrician-gynecologist, is president of the National Medical Association, which represents black doctors. She said the report proves what many doctors and other health care professionals know to be true: discrimination and bias exist in health care settings.
“It's important to quantify that and put it in a more reliable format,” Lawson said. “For a lot of doctors and health care workers of color, it’s not uncommon for them to recognize that or call it out.”
Young workers are more likely to notice discrimination
The telephone and online survey was conducted from March 14th to April 5th, 2023, and included responses from more than 20 types of healthcare professionals, including doctors, nurses, associate nurses, dentists, medical assistants, dental hygienists, and internists. Answers have been collected. Assistant, mental health worker, administrator.
Henry Fernandez, chief executive officer of the African American Research Collaborative and lead author of the report, said the study focused on black and Latino people to ensure an adequate sample size to reduce margin of error. It said it “oversampled” American and Asian Pacific Islander health care workers.
Among other findings, the report's authors say it speaks to the generational disparity among health care workers, with 59% of workers under 40 facing stress due to discrimination. In contrast, 26% of workers over 60 said they faced discrimination. Younger workers were more likely to be aware of discrimination or to notice signs of it.
Zephirin said discrimination was a “key area to address” in order to attract and retain workers amid widespread shortages of health care workers.
Fernandez said “one of the things that really stood out to me” was that younger workers were more likely to notice discrimination against patients.
He said this is a critical area of focus, especially as the healthcare industry hires and trains younger workers to address chronic workforce shortages.
The report recommends several amendments to address discrimination in health care settings, including training for medical staff to identify discrimination and training for schools of nursing, medicine, and other health schools. These include requiring classes on discrimination. Another suggestion is to create a way for patients and health care workers to anonymously report discrimination. The report suggests that health systems take on this task, to encourage workers and patients to report instances of discrimination and racism, while protecting the identity of those making complaints.
Hospitals and other facilities will also need to consider how to accommodate non-English speakers. According to the report, Latino health care workers said patients who speak languages other than English were not always treated equally.
a lesson in respect
Another finding from this study also resonated with many people. Almost half of health care workers surveyed said they were more willing to accept a white patient than a black patient when a colleague insisted on treating a white patient. Overall, 48% of healthcare professionals cited discriminatory treatment of patients who advocated for their claims, according to the report.
Zephirin said the disparate treatment for patients who advocate for themselves is concerning. In an ideal environment, Zephirin said, patients should be encouraged to ask questions and notify their supervisors if their doctors or nurses aren't meeting their needs.
But the report suggests that if patients try to advocate for themselves, they may be treated differently based on their race.
Lawson, a specialist in Dallas, said that during her third year of medical school, she noticed that some doctors were not talking about their patients and listening to their concerns. During her student years, she was with a group of other medical students, young doctors, and preceptors from Veterans Administration hospitals.
A physician supervising medical students and residents described bedside care for elderly black veterans. Lawson recalled that the veteran was confused by what the doctors were discussing, but no one took the time to explain it to him.
As the group of residents and medical students moved on to the next patient, the man held out his hand to Lawson, the only black person in the group.
“He asked, 'What did they say?'” Lawson said.
She explained the man's X-ray results and other details of his treatment for multiple chronic conditions. This is a lesson she has retained and applied throughout her professional career, and one she passes on to younger doctors.
“You talk to the patient. You involve the patient in their care,” Lawson said. “All I really want is for everyone in the health care system to be respected.”
