While there has been much discussion about improving "the patient experience," until recently there has been little attention paid to protecting staff from abusive, sexist, or racist patients. In this app video, , a cardiologist at the Mayo Clinic in Rochester, Minn., says that is just beginning to change -- hospitals must develop policies and procedures that will help staff know what to do when a family member abuses them or a patient demands to be seen by a doctor of a particular race, sex, or age.
Following is a transcript of her comments:
One thing that really came to the fore over the past year or so is that there is an increased frequency of patients' and visitors' misconduct, bias, or inappropriate request for types of healthcare providers that is irrelevant to the type of care, such as asking for an American or the gender, or the religion, or the age of their provider. Then also whether it's people feeling like they need to not quite be as politically correct, often saying things to their providers, their nurses or trainees, that is outright discriminatory or harassing.
We have observed this and have sort of polled other healthcare systems and they, too, have observed it but most of us in healthcare were not prepared. The reason we weren't prepared is we may have 20 or 30 policies to protect our patients, and in this regard, most of us did not have policies or procedures to protect our staff. A recent online survey showed that over 60% of doctors and about the same number of nurses have had some discriminatory or biased comment or action made against them, and over half of them had recalled that a different type of provider had been asked for by a patient.
The most common, at least of a physician type who are affected, are those who we may be less attuned to. They're the nurses. They are those who work in the ED. They're our trainees. What we recognize is many of the faculty and senior physicians may not be aware.
As we started looking at this, we realized, perhaps -- and this is something that we certainly felt like, perhaps, at Mayo -- is our focus on the needs of the patient coming first has, perhaps, eclipsed or become a little unbalanced towards meeting the needs of our staff and protecting our staff, honestly.
We've really kind of done a deep-dive into what we needed to do to support our staff culturally, policy-wise, as well as to say, "Yes, we want to meet the needs of the patient, but not necessarily the wants of the patient." When a patient calls to make an appointment and they said, "I want an American doctor. I only want a male surgeon. I only want or have to have," I'm not saying that we're perfect, but we have a policy in place that basically says no to those requests for an outpatient.
Now, this is nuanced because if you have a critically ill, cognitively impaired, or an emergent situation, we must provide care. And if the only physician, the only cardiologist who's available to do an angiogram is a black man, and that patient is wearing a Confederate flag bandana and is spewing racial epithets, we need to care for that patient. But we also have to care for that staff member. That's the other part of this issue is, for too often, our staff, our nurses, our trainees were suffering in silence. They were not reporting this. In fact, they felt personally shamed and blamed when these things happened.
We put together a new policy because we looked and nobody wants [LAUGHTER] ... every organization wants to have fewer policies and have them consolidated. We realize we, at Mayo Clinic, had no policy. I did a show of hands of about 50 organizations, CMOs and CNOs. I said, "How many of you have a policy?" Three hands, including ours, went up. How many have had one for more than a year? Only one hand went up. This is something that, as I talk to colleagues, we haven't been quite ready for this change.
The policy talks about what to do when, and provides guidance to our staff what to do when patients request a type of provider or not having a type of provider that's unrelated to care. Then also, harassing, discriminatory, and other misconduct. I think it's important as we -- and we also developed a reporting mechanism and asking for people to report not just the really bad ones, but also any requests, because one of the things that we recognize is we don't know the frequency of this. It's much more than we previously thought.
We've gotten some very egregious reports of patient misbehavior, but what surprised me coming from a diversity and inclusion lens, and knowing that many of the people who are being affected were women and minorities, is that there were some equal-opportunity bullies as patients. Or they were running around, and at almost every desk or department that they had their care, they were disruptive, mean, rude and disrespectful. This allows us to identify those individuals and help with that.
What do we do? It's everything from saying no to an outpatient appointment request to -- actually there was an example in our own department, a patient who was really misbehaving in many ways. She was abusive to the desk staff, abusive to the physicians and the residents, and the department chair. She was declined an appointment. She called back and said, "I want my care." There was actually a behavioral plan written. She signed it and she's a great patient now, but we didn't feel empowered previously, necessarily, to call that individual out. I think the awareness of who's in the target of this patient misbehavior and recognizing it's probably not a senior, gray-haired, white male -- because many of them behave when he walks into the room -- and recognizing that we have a responsibility to some of the other vulnerable individuals.