Speaking out

‘Discrimination affects us all’: When physicians experience prejudice

A recent study offers strategies for physicians on dealing with discrimination. Two DOs weigh in on the advice.

Ashley Denmark, DO, was on a Hawaii-bound flight with her husband when the Delta flight crew asked if a doctor was on board. But when Dr. Denmark, a second-year family medicine resident in Florence, South Carolina, volunteered to assist, she says the flight crew was skeptical that she was really a physician. Ultimately, Dr. Denmark, who is African-American, was directed to sit down while two nurses, who were white, attended to the sick passenger.

Ashley Denmark, DO

In a blog post shared by the New York Times and the Washington Post, Dr. Denmark explained it wasn’t the first time she’d encountered discriminatory assumptions. “As an African-American female physician, I am too familiar with this scenario,” she wrote. “Commonly, I’m mistaken for an assistant, janitor, secretary, nurse, student, etc., even when I have my white coat on.”

Dr. Denmark’s experience followed a widely publicized incident this fall in which Tamika Cross, MD, an African-American physician, was denied the chance to help a sick passenger on a Delta flight. The incident prompted outrage and thousands of tweets using hashtags like #whatadoctorlookslike and #PhysiciansToday, which was created by the AOA’s Bureau of Emerging Leaders to highlight diversity among physicians.

Perla del Pino-White, DO (Photo provided by Dr. del Pino-White)

Perla del Pino-White, DO, a family medicine physician in Fort Lauderdale, Florida, has also encountered discriminatory comments on the job. “Sometimes patients make comments to me about Hispanic people, not realizing I’m Hispanic, or about African-American people, not realizing I’m Afro-Cuban,” says Dr. del Pino-White.

In other cases, patients have told Dr. del Pino-White about encounters with health care professionals who made disparaging remarks about their ability to speak English. Whether discriminatory language comes from a patient or a health care professional, Dr. del Pino-White says, physicians can react by pointing out the importance of respecting diverse cultures and not judging others based on appearances.

Addressing discrimination

Other physicians have had patients refuse treatment or ask for a different clinician because they don’t want to be seen by a physician of a certain ethnic background, religion or gender. A recent study from the journal Academic Medicine offered tips for resident physicians on dealing with this situation and patients’ discriminatory comments. Here’s a sampling:

  • Reflect on your values as a medical professional: The first priority is to care for the patient.
  • If the patient isn’t in immediate danger, try to learn what’s at the root of the fear. Doctors can use language such as, “What are the things you’re really concerned about? Tell me what you’re afraid of. All members of our medical staff are highly qualified.”
  • If medical residents face discrimination in a nonemergency case and attempts to de-escalate the situation are unsuccessful, it’s OK to have a colleague care for the patient instead.
    • Neil Jain, OMS I, who attends the Rowan University School of Osteopathic Medicine in Stratford, New Jersey, recently shared a message of solidarity with Tamika Cross, MD, and other physicians affected by discrimination on Facebook. (Photo submitted by Neil Jain, OMS I)

      The study’s recommendations are a good starting point, say Drs. Denmark and del Pino-White, who also suggest:

      • Being open with colleagues about discrimination. “When these things occur, it’s important to share so you can open up dialogue and bring positive outcomes from a negative situation,” says Dr. Denmark. After she blogged about her Delta experience, for example, the airline apologized to her and is working to improve training for flight crews.
      • Drawing on your DO training to model openness and inclusivity.
      • It’s important for all physicians to be aware of the problem and support colleagues who experience discrimination, Dr. del Pino-White says: “Regardless of your own race, religion, age or gender, discrimination affects us all.”

19 comments

  1. How do you successfully navigate a situation where your medical director is the one who is biased?
    It was time to start renegotiating and he told me to go home and ask my husband if it was alright with him!

    1. If this guy really said that, you should call him on it. “Doctor X, do you really want me to ask my husband for permission?” Dr. X, that is not what you really mean is it? Then go on to restate the issues, and extract a solution. If that doesn’t work, you have to decide if raising the issue to the more senior leader is worth the battle – need a cost benefit analysis.

      If you lose this battle, you have to decide was it you? or was the issue the Med Dirs. If it is the latter, maybe you should look for another program.

      It is hard to fight city hall. You might win, but you have to decide if it is worth the personal and professional cost.

      Best wishes

      btw…as a long time physician executive, if what you say is true, this guy needs the boot :)

  2. I have experienced insensitive comments about my age and my weight at the osteopathic school where I teach. These comments were made in front of medical students!!!!! Discrimination is everywhere sometimes right in front of us.

  3. In regards to Dr. Denmark’s unfortunate incident, much more is required to be elaborated upon before pulling the trigger on discrimination.

    For instance, the specific facts of the case. Is this Dr. Denmark’s interpretation only? The article did not interview any other witnesses.

    Perhaps she is overly sensitive and other reasons regarding her behavior and actions (aside from her race) played a role in her experience.

    Has she made previous claimed of discrimination in the past?

    Or maybe the two RNs who responded had more experience then her (e.g. critical care NPs with a decade of acute care medicine experience)?

    To jump at “discrimination” is a regrettable presumption and further fans the flames of an already tense political environment in our country. It’s unfortunate to see the AOA jump on the band wagon in a completely pandering and laughable article for anyone who has any critical thinking ability.

    Victimization is no longer taken seriously from certain minority groups. This is sad because it undermines the cases of racism which are actually genuine. (e.g. The boy who cried wolf). This is reason why Reverend Al Sharpton is a divisive figure.

    Fortunately, given the results of the presidential election, the winds they are’a changn’!!

    1. Yes, Dr. D is absolutely correct. When I was out of training, 28 years old and very young looking…i.e. 14 y/o, had a similar situation. Met with doubt, my response was to demonstrate competence through behavior. I bet you a nickel that our young resident was not as assertive as were the nurses. This is 2016…from a doc who has lived and practiced in very diverse cultural communities, I have never seen intraprofessional discrimination…never….only discrimination based on behavior. Do you instill a level of competence. I would take this as a lesson on how you present your self and expertise, and put the racial aspects on the back shelf. Can racial prejudice exist? Sure, but it is very rare in professional situations. Probably not the answer you want to read. Take it as tough love. bc

  4. I am a practicing physician in a rural, under served area. I also have a slight speech impediment. I practice in family medicine has always been incredibly busy. I am the busy his doctor in our clinic. I have delivered over 4000 babies and done over 1000 cesarean sections. The discrimination that I have face has come from professors of family medicine when I was a student. I was told that patient would never see a doctor who has a stuttering problem. I was also encouraged to drop out of medical school because of this. Fortunately, I did not listen to them. While I was a student, I was frequently picked on and teased by attending physicians who thought it was funny. My advice to do medical students who are discriminated against in any way to keep moving forward and bring this to everyone’s attention

  5. So the issue of medical care by a professional on an airplane is a recurring one. If you want to put yourself in the role of physician good samaritan, you simply must have your credentials with you. I know first hand with a recent flight from LAX to Boston. I was not welcome to assist a very ill lady until I produced my hospital ID and my state license. Years ago, I simply got up to help and everyone was relieved- no questions asked. I am wondering if the change now is that there is a sophisticated medical aid kit on board with injectable medications. Maybe that is the issue. American Airlines has a ground link with a 24 hour physician back up for the flight crew which is helpful to them. Finally, at the moment of 9/11, I had a number of colleagues who went to emergency rooms to offer assistance to a overwhelmed system. Those with their hosptial ID’s were welcomed to help. Those with out credentials were turned away. I get the nasty innuendo that comes with the assumptions made by the flight crew as told in this article and wish it didn’t exist. But most of it can be ended quickly by carrying your credentials with you. Hope this is helpful.
    RP

  6. And then there are physicians who discriminate. In the Detroit area we had a D.O. recently who refused treatment to an infant because it was adopted by a gay couple. The physician’s excuse was her religion. Religion should have nothing to do with the treatment of patients or their families.

    1. That is bizarre and I have enough life experience to be extremely sceptical that any “sane” physician would knowingly refuse care to a newborn owing to the parent’s sexuality. Impossible? No. Just highly improbable.

      Please refer me to your sources. Was it a news paper? Magazine? Blog? Or did you hear it from the gay couple yourself?

      Discrimination is a very serious accusation. I’m sure you wouldn’t level it against a colleague without adequate proof, correct??

      1. Easy to Google. I refer you to the Detroit Free Press of Feb. 19, 2015. There are many other references you can find. Just Google “physician refuses to treat infant of gay couple”. If I can be of any further help. let me know.

        As a physician, especially a DO, it was very disconcerting to me.

        kaufmanherbdo@gmail.com

  7. Not all victims of discrimination are people of color or female, I am a Chassidic Jewish male and have been the victim of discrimination both when in the Army and while in private practice. Discrimination can also occur because of belief systems, even within medicine, it can occur whenever you are different and especially if you lack pride and confidance in who you are. My advice is to stop whining and playing the victim and work on your self esteem all the while understanding that people will tend to fear anyone who is different.

  8. Endured discrimination, bias, poor manners all my career from colleagues, RNs and patients however I keep moving forward and don’t let it bother me.
    I am reminded that I too make remarks that can be interpreted as discrimination, dumb, inappropriate or rude. I didn’t intend to say it that way but I get it, my words can land differently then intended.
    Rise above all this, be the leader that you are.

  9. “…it’s important to share so you can open up dialogue and bring positive outcomes from a negative situation.” – Dr. Denmark.

    Such a great comment that offers a solution, not just in regards racism, but on facing conflict head-on and in a constructive way.

  10. Very good points. Good Article!

    Racism can be defeated by an honest education process. This requires the commitments of the politicians. Will they do this? Why would they?

    Racism comes from one group or groups of people trying to assert power over another group or groups of people for the economic benefits most of the time. Cheap Labor!

    How do we deal with this? This is the dilemma!

    On the Note of Discrimination against the DOs still!

    ONE Blatant discrimination that I have seen over and over over the last 20 years is that from FMG doctors. Most FMGs are minorities and should be grateful in that they get a chance to practice in the USA. Especially the FMGs from Canada! That is not to say that the American MDs are not doing it. I applied for a fellowship at Loma Linda University and via a back channel I was told that they will not consider my application because I am a DO in spite of the fact that I did an ACGME residency from a program that was ranked much higher than this one. Yet Loma Linda hires many FMGs. As we merge our OGME and ACGME, we have to start highlighting this decriminalization as well.

  11. I, too, have been the victim of discrimination. I have a neurological disease that affects my walk. I decided I’m not going to let anyone or anything get in my way of me becoming a physician. My A&P instructor in college made comments like “Oh here comes ol’ gimpy” and “Here, takes these papers to the front office for me” knowing I don’t walk very well. And this was in front of the class. I would sometimes get to class early, so he wouldn’t see me walk in and make comments. And if this is just in undergrad, I can just imagine what medical school will be like.

  12. as an aside…..you are probably going to see more prejudice against you because you are a DO….not like the old days, but buckle up, it will be there.

    Sure there are bigots out there, all flavors, accept it and make yourself a bigger and better person. Don’t adopt the “poor me” victim persona.

  13. all good points…but bottom line is there is always discrimination…everywhere….either you whine about it or accept it and move on. Guys and Ladies, move on.

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