Faculty Guidelines for Responding to Inappropriate Comments from Patients and Family Members in Clinical Environments

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It is important to address inappropriate comments in real time. Failure to respond to these comments provides permission to whoever said them and is not supportive of learners.

While it is important to respond in real time, maintaining a professional and respectful demeanor is also important. Speaking calmly and clearly will increase the likelihood of being effective in addressing inappropriate comments.

Here are some possible responses to a variety of inappropriate comments. Some are more direct than others. Faculty should feel free to choose whichever works best in the situation they are facing, taking into account the context in which comments are made.

Derogatory comments about race/ethnicity

• “We know you are here to get the best medical care possible – and we want to provide you with that care. In order for that to happen, we need to treat each other with respect.”
• “Please do not use that type of language as it is offensive to others and not acceptable in this medical center.”
• “Making comments like that is disrespectful, and we cannot tolerate that kind of language.”
• “We are here to help you, but it is hard to do that when you use language like that.”
• “That is not a word/term we use here.”

Being asked “Where are you from?”

• “Why do you ask the question? It will be helpful to understand how this will help me provide you with the best medical care.”
• “I am from (place), but let’s spend our time today focusing on your health.”

Comments about appearance

• “Let’s focus on facts and issues that are relevant to our ability to provide you the best quality medical care.”
• “I know you mean well, but we are more concerned about our learners’ knowledge than their appearance.”
• “We’re trying to help you. It is hard to do that when you make comments like that.”

After an event where inappropriate comments are made, faculty should consider taking a few moments to support the learner(s) who were impacted by the comments. Asking if they would like to talk about the incident can be helpful. Also, inquiring about the adequacy of the faculty response can also be informative.

Suggested questions/comments to learners

• “That was difficult; how are you feeling?”
• “It is really important that everyone feels safe and comfortable here. I want to hear about things like this.”
• “Everyone should feel empowered to speak up when things like that happen. I will support you.”
• “I am so sorry this happened to you. I can’t imagine what this experience has felt like. How can I best support you with this? How do you feel about continuing to work with this patient?

There may be occasions where a patient or family member may request that a provider not treat them because of some aspect of the provider’s diversity. The medical center has a policy, 33 HAM, that prohibits a patient or family member from requesting a different provider based on that individual’s aspect of diversity (unless, if the request is based on gender, there are extenuating circumstances for honoring the request, such as religion or trauma). Inform students of this policy and that they are protected from such behavior as well. Similarly, there may be times when a patient does not want a medical student/resident involved in their care.

Suggested responses

• “You have the right to choose your provider, but that choice cannot be based on discriminatory reasons. You also have the right to refuse care, but understand that refusing the care from a specific provider is the same as refusing the care altogether. We do not have to provide an alternate provider in response to your request. We will consider your refusal of care by this provider as a request for discharge, which would be against our medical advice.”
• “As an academic medical center, we are committed to providing patients with the best medical care while preparing tomorrow’s physicians to also provide this quality care. The student will not be caring for you, but merely observing or being queried about what care should be provided.”
• “As an academic medical center, we are committed to providing patients with the best medical care while preparing tomorrow’s physicians to also provide this quality care. The student will be closely supervised and will be under the direction of a physician.”