Establishing a Culture of Respect: Responding to Patient-Initiated Harassment

During an interactive poll during the session “Allies and Bystanders,” 60% of attendees said they have been harassed by a patient or patient’s family in their practice. Nkanyezi Ngwenyama Ferguson, MD, FAAD, micrographic dermatologic surgeon at the University of Missouri Health Care and Marta Jane Van Beek, MD, MPH, FAAD, clinical professor of dermatology at the University of Iowa spent a power hour sharing strategies to address patient-initiated harassment at the 2023 American Academy of Dermatology Meeting in New Orleans, Louisiana.¹

Everyone has an identity, whether it’s based on race, ethnicity, sexual orientation, gender identity, ability, religion, nationality, or socioeconomic status. Ferguson and Van Beek wanted to help participants recognize different forms of identity-based harassment and mistreatment and the impact of it in a daily clinical environment.

“It can be tough to call out inappropriate comments—especially when your institution measures patient satisfaction and you’re just too busy or exhausted to call out negative behavior,” said Van Beek. “The impacts of discrimination, harassment, and microaggressions have lasting impact on a clinician’s performance, mental health, and career.”

What are the differences between discrimination, harassment, and microaggression?²

Knowing the difference between the 3 terms can help health care professionals identify, speak up, and report behaviors that affect the culture of the practice.

Discrimination is the differential treatment of an individual based on their identity group(s). For example, “A veteran is not given a raise because they are a veteran.”

Harassment is unwelcome conduct, verbal or physical, including intimidation, ridicule, insult, comments, or physical, that is based on an individual or group’s identity. For example, “A nurse in the LGBTQ+ community is called derogatory names because of their sexual orientation.”

Microaggression tends to be tougher to identify. It is defined as verbal, behavioral, or environmental indignities that communicate hostile, derogatory, or otherwise negative prejudicial slights and insults. For example, “A female physician in a healthcare institution is assumed to not be a physician because she is a woman.”

“We as a society need to recognize the cumulative effects of microaggressions,” Van Bleek expressed during the session. 

Research shows the long-term impact of microaggressions can lead to increased rates of depression, prolonged stress and trauma, anxiety, even heart disease and type 2 diabetes.³

How can I respond when a patient or their family says something hurtful to me or someone on my staff?

Van Bleek passed out the I-RESPOND Toolkit⁴ to all session participants and it outlined ways to respond if you choose and how to follow up with your practice’s team to foster an environment where everyone feels valued. When asked during the session, more than 80% of participants said in an interactive poll that they had never received training for this.

The I-RESPOND Toolkit outlines the acronym, which stands for:

• Use “I” Statements
• Repeat and Clarify Statement
• Emphasize Shared Goals
• Set Boundaries
• Patient Actions Rather than Person
• Offer an Alternative
• Separate INtent from Impact
• Don’t Use Humor

The kit also provides solutions if you see the harassment of a colleague with tips including:

• Establish a culture of openness and respect.
• Respond to the harassment in real time.
• Validate and offer support.
• Encourage reporting and documentation of patient harassment.

References

1. Ferguson N, Van Bleek M. Allies and Bystanders. Presented at American Academy of Dermatology 2023 Annual Meeting; March 17-21, 2023; New Orleans, LA.

2. Nitkin K. Bullying, microaggression and other terms. Bullying, Microaggression and other Terms. Published January 28, 2020. Accessed March 20, 2023. https://www.hopkinsmedicine.org/news/articles/bullying-microaggression-and-other-terms.

3. Carter RT, Mazzula S, Victoria R, et al. Initial development of the race-based traumatic stress symptom scale: Assessing the emotional impact of racism. Psychological Trauma: Theory, Research, Practice, and Policy. 2013;5(1):1-9. doi:10.1037/a0025911

4. University of Iowa Health Care. I-RESPOND TOOLKIT Addressing patient-initiated identity-based harassment. 2019.