Hate speech in healthcare

Hate speech and microaggressions from patients directed toward clinicians in healthcare settings are unfortunately a common occurrence.  Hate speech is defined as verbal or nonverbal communication that attacks, threatens or insults individuals or groups based on various characteristics. Hate speech and microaggressions experienced by clinicians can range from explicit refusal to receive care from clinicians (based on clinician characteristics such as race, gender, age, religion, accent) to remarks such as, “Where are you really from?” or “You’re too pretty to be my doctor!” Even when patients’ comments are meant to be benign, they signal that the clinician does not belong in the healthcare setting.

Regardless of intent, the consequences for clinicians, lead to fear, cause distress, accelerate burnout and introduce moral discomfort. Although common, many clinicians struggle with how to respond to such behavior due to a lack of guidance and concerns about professionalism when their aggressors are patients. To address this issue, the Veterans Health Administration (VHA) developed a 1-hour webinar providing ethics training and guidance on working with patients who use hate speech. The webinar aims to educate clinicians about the motivations behind hate speech and provide strategies for appropriate responses. The webinar is freely available here for further learning and professional development.

We recently coauthored an manuscript evaluating this 1-hour webinar. A total of 668 participants completed the evaluations, including social workers, psychologists, nurses, physicians and counselors.

Our evaluation revealed several themes. Participants appreciated the open discussion of difficult subjects and the inclusion of evidence-based articles, real-world examples and discussions in the chat box. They found it useful to have clear examples of professional responses to various situations, incorporating inappropriate language that reflected real experiences.

The training also led to a discussion about hate speech, highlighting the lack of guidance in managing hate speech during clinical encounters. Participants reported a better understanding of patient behavior, realizing that not all inappropriate speech is intentional and this understanding enabled them to respond more compassionately. Moving forward, participants expressed a motivation to discuss the training with colleagues and trainees, as well as implementing strategies learned during the session.

Recommendations from participants included requesting more time or additional sessions, more advanced material and perspectives from diverse presenters, including women and people of color. Participants also noted the value of rehearsing responses to complex examples and worst-case scenarios to better prepare clinicians.

Overall, the evaluation indicated that the webinar was well-received and had a positive impact on participants’ knowledge, skills and attitudes. It facilitated open discussions, provided insights into patient behavior and motivated further dialogue and action within clinical teams. Participants appreciated the opportunity to learn and discuss strategies for responding to hate speech and expressed a desire for continued training and support in this area.

Our hope is that more people watch this webinar and gain needed guidance on how to respond to hate speech, understand patient motivations and support co-workers. On a larger scale, there is an opportunity for institutional policy to advance this issue. We recommend that institutions directly address hate crimes by encouraging frequent discussions, holding annual trainings, providing/promoting free resources and adding learning modules into ethics curricula.

By Dr. Jennifer Bryan, Assistant Professor, Psychiatry & Behavioral Sciences, Baylor College of Medicine, Investigator, South Central Mental Illness Research, Education, and Clinical Center (MIRECC) and Investigator, Center for Innovations in Quality, Safety, and Effectiveness (IQuEST); Moushumi Sahu, School of Social Sciences, Rice University; Dr. Thomas Mullin, George E. Wahlen Deptartment of Veterans Affairs Medical Center; Dr. Ali Abbas Asghar-Ali, Associate Professor, Psychiatry & Behavioral Sciences, Baylor College of Medicine, Associate Director for Education, South Central  Mental Illness Research, Education, and Clinical Center) and affiliates. (MIRECC), Investigator, Center for Innovations in Quality, Safety, and Effectiveness (IQuEST)





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