Page 24 - ASCO Cultural Competency Toolkit

Addressing Patient Bias
Physicians and health care workers have employment rights that must be balanced with patients’
rights. Under Title VII of the 1964 Civil Rights Act, healthcare workers have employment rights such as
the right to a workplace free from discrimination based on race, color, national origin, religion, and
sex. Patients also have the right to refuse medical care due to informed-consent rules and common
law protections, and can refuse specific tests, treatments, or treatment by an unwanted physician.
The patient’s medical condition (for example, emergent or routine) and the clinical setting should
drive decision making, as well as the reasoning behind any patient's request for physician
reassignment. For example, in certain scenarios, requests for an ethnically concordant physician may
be ethically appropriate if for religious or cultural reasons. Additionally, if there is a prior history of
discrimination, post-traumatic stress, or negative experience with the health care system that has
resulted in mistrust, then physician reassignment may be justifiable and can improve patient
satisfaction.
Organizations must work to ensure a balance between the two parties, as making race-based staffing
decisions or complying with a patient’s request for reassignment on the basis of a worker’s race or
ethnic background may violate Title VII (Kimani et al, 2016). If the request for reassignment is based
on bigotry or explicit bias, then the request should be considered carefully. The effect on the physician
should be the final consideration since for many minoritized health care workers, patients’ racial
preferences can be painful and degrading, which can “cumulatively contribute to moral distress and
burnout.” (Kimani et al, 2016) Of note, nurses and nursing assistants have successfully sued employers
who require employees to accommodate patient demands for physician reassignment based on race.
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