Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Demeaning Patient Behavior Takes Emotional Toll on Physicians

Key clinical point: Patient bias persists in modern medicine, largely based on physicians’ social characteristics, and can negatively impact all care providers present.

Major finding: Biased and demeaning patient behavior included refusing care, questioning the clinician’s role, ethnic jokes, and inappropriate flirtations or compliments.

Study details: A qualitative study of 50 internal medicine hospitalist physicians, residents, and medical students affiliated with the University of California, San Francisco, School of Medicine.

Disclosures: The study was supported by the Greenwall Foundation. The authors reported no conflicts of interest.


Wheeler M et al. JAMA Intern Med. 2019 Oct 28. doi: 10.1001/jamainternmed.2019.4122.


The results of the patient bias study from Wheeler et al are troubling, but not surprising.

As the physician workforce becomes more diverse in regard to race, ethnicity, sex, gender identity, and sexual orientation, considering and addressing the negative impacts of demeaning patient interactions becomes increasingly important. And though a recent analysis stated a decline in biases between 2007 and 2016, discriminatory and disrespectful treatment remains the norm for members of many minority groups.

Strategies to address these behaviors include codes of professional ethics offering guidance on responding to disrespectful behavior, antidiscrimination training for all health professionals, and health care leaders themselves practicing and preaching respectfulness and civility within their institutions.

Patients can only be expected to behave respectfully towards physicians if the culture of health care is also respectful.

When anyone, including a patient, exhibits biased and disrespectful behavior, silence is not golden. It is tacit approval. We all have the responsibility to speak and act.

Lisa A. Cooper, MD, and Mary Catherine Beach, MD, of Johns Hopkins University in Baltimore; and David R. Williams, PhD, of Harvard University, Boston, made these comments in an accompanying editorial (JAMA Intern Med. 2019 Oct 28. doi: 10.1001/jamainternmed.2019.4100). They reported no conflicts of interest.