THE ELEPHANT IN THE ROOM

Have you recently gone to care for a patient, then you introduced yourself then they went on to ask for your ethic name and a comment like"but you don't look like them," follows. Or you are busy triaging, then the question of what kind of doctors do you have crops up. Or those who are more specific and say "I want a Somali doctor or I want an Asian doctor they are the only ones who provide good care."Or someone blatantly asks you, "so what is your ethnic background" all while you are providing care and makes a very bigoted comment. Or yet still, maybe you were working with a doctor on how best to attend to a patient and the family says something like" no! we need a real doctor someone who is older, not this young fellow who is an intern."  Or my best, "you are too young to be working and are you even sure you know what you are doing."If you have experienced this I would wish to discuss how you handled it for I feel we often dismiss it but it creates a detrimental work environment.

A literature review conducted on several databases including PUBMED, HINARI, Google Scholar, Medscape, and NCBI reveals one thing, more needs to be done. There is little to no data on bias directed to health workers by patients yet a lot of studies have been conducted on health workers' biases towards patients. Does it mean that we have become so comfortable accomodating this behavior that it is part of the norm?

I chose to join the minority and actually voice it. Most of the journals available proved that it is quite a common phenomenon and unfortunately little has been done by most organizations to curb it. This is sad because such remarks then raise questions on how we should think of race, ethnicity, health, and individual autonomy. With the patients' right to medical care and the unspoken rule of complying with patients' preferences (let us be honest it happens quite often) how then do we reconcile patients' autonomy and accepted levels of ethnic, gender and religious equality. Please review the following article to see how it prompted such thoughts;
https://heinonline.org/HOL/LandingPage?handle=hein.journals/uclalr60&div=13&id=&page=.
try comparing how this article raises questions on issues that we as a country fail to even address in our current health bill. this is despite us being a middle-income country interacting with people from all over the world and facing these challenges daily. Where are we failing? Is it in failure to participate in the generation of policies that govern us as health workers. Please share your thoughts I am quite interested to hear from you?
Please find a sample of the journal links
https://journalofethics.ama-assn.org/article/how-should-organizations-support-trainees-face-patient-bias/2019-06?Effort%2BCode=FBB007
https://www.shrm.org/resourcesandtools/hr-topics/behavioral-competencies/global-and-cultural-effectiveness/pages/metoo-sparks-bill-to-stop-culture-of-silence-in-workplaces.aspx
https://www.statnews.com/2017/10/18/patient-prejudice-wounds-doctors/
http://kenyalaw.org/kl/fileadmin/pdfdownloads/Acts/HealthActNo.21of2017.pdf.

Basis of bias

A Medscape survey done in 2017, showed that among consumers who participated in the study their choice of health worker preference was linked to ;

• Sexual orientation (11%)
• Ethnicity (8%)
• Religion (7%)
• Political views (6%)
• Race (5%)

The study also clearly states that at times the perceived bias "might just be a poorly explained preference." For instance due to previous negative experiences with doctors of other ethnicities etc. What if the preferred professional doesn't have the needed skills yet, will we comply with a patient's request? Quite a murky zone right? It is quite important to address it so that we limit race/ethnicity health disparities, improve health outcomes and at times quite honestly save lives. Please follow the link to further analyze the said study https://www.webmd.com/a-to-z-guides/news/20171018/survey-patient-bias-toward-doctors-nurses.

Challenges faced by health workers who experience bias

• Disrupts team harmony.
• It impairs one's self-esteem and self-worth.
• Risk of hampered relations with other patients.
• It creates a moral-ethical dilemma for the health worker and organization.
• Complying and failure to comply can lead to Lawsuits.

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What can we do?

Some of the recommendations from various articles revealed that;

1.  Comply with basic ethical guidelines through; evaluating the patient’s
medical condition; assessing the patient’s decision-making capacity, determine the
patient’s reasons for the request, the available options for responding, and the effect
on the health worker.

2. Try using problem-solving techniques especially if it may end up affecting their health. The techniques include negotiation, persuasion, and, if necessary, accommodation.

3. When such an event occurs it is important to conduct an assessment on the aggrieved staff, conduct a debriefing with affected staff, convene team meetings, conduct an event tracking, data collection, and initiate organizational cultural changes.

4. Being that our in set-up one is more likely to experience ethnicity bias. I would recommend if our work ID tags only displayed neutral names or rather the legal name one felt more comfortable using. I believe this would limit some awkward conversations we often get bombarded with.

5. Put more emphasis on educating the health workers on their rights and roles and have more organizations creating policies that also protect the health worker.Please follow this link https://lilylovelong.blogspot.com/2020/01/change-must-come.html.

In conclusion, we need to continue generating difficult conversations. Change can only occur when we openly declare the sad truths and deal with them. For