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- Presentation
Workshop on Responding to Patient-Initiated Identity-Based Harassment in Clinical Settings
Description
The workshop, led by clinicians from the University of Iowa and Howard University, focused on how to recognize and respond to identity-based harassment initiated by patients in clinical settings. It defined discrimination, harassment, and microaggressions, and shared real-world examples of biased or sexualized comments directed at clinicians and trainees. Presenters reviewed evidence that patient harassment is common, especially toward physicians of color, women, and trainees, and is linked to burnout, distress, and suicidal thoughts, yet is rarely reported because people fear conflict, retaliation, or believe nothing will change. The session emphasized creating a safe, confidential, and interactive learning environment, then taught practical response strategies from a toolkit: using “I” statements, repeating and clarifying offensive comments, emphasizing shared goals of care, setting boundaries through office policy, focusing on behavior rather than character, offering alternative terms of address, focusing on impact rather than intent, and avoiding humor that can reinforce bad behavior. Participants practiced these responses in scenarios and discussed the importance of pause, empathy, and allowing the targeted person agency when appropriate. The workshop also highlighted the role of bystanders as upstanders, encouraging real-time intervention, debriefing afterward, and supporting colleagues so they feel seen and protected. Finally, it stressed that effective anti-harassment policies, reporting systems, documentation, and team training are essential, and that preparing in advance helps normalize intervention and make harassment less acceptable over time.
View moreConclusions
- Patient-initiated identity-based harassment is common in healthcare and disproportionately affects trainees and clinicians from marginalized identity groups.
- Such harassment contributes to burnout, reduced job satisfaction, poorer work performance, mental health strain, and even suicidal thoughts.
- Underreporting is a major problem because many clinicians do not believe reports will be addressed, are unsure how to report, or feel incidents are not serious enough.
- Current harassment training is often insufficient because it is passive, focused mainly on sexual harassment, and does not teach real-time response skills.
- Effective responses should be practiced ahead of time and can use a simple script that is brief, empathetic, and nonjudgmental.
- Useful response strategies include using I-statements, repeating and clarifying the comment, emphasizing shared goals of care, setting boundaries, focusing on the behavior rather than the person, and separating intent from impact.
- Humor is usually a poor way to respond because it can minimize the harm and unintentionally reinforce the behavior.
- Bystanders should not stay silent, because silence can function as complicity and can make the target feel unprotected and isolated.
- When harassment is witnessed, supervisors and colleagues should intervene in real time when appropriate, or debrief and support the target afterward if immediate intervention is not possible.
- Institutions need clear anti-harassment policies, accessible reporting systems, documentation practices, and a culture that expects, addresses, and does not tolerate discriminatory patient behavior.
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