"This happens all the time": a Qualitative Study of General Internists' Experiences with Discriminatory Patients.

Background: Workplace discrimination negatively affects physicians of color personally and professionally. Although the occurrence of discrimination from patients has been visible in social media, popular press, and personal essays, scant research exists on patients as a source of discrimination directed at physicians of color.

Objective: To explore practicing general internists' experiences observing or interacting with patients exhibiting discriminatory behavior directed at physicians of color.

Design: A qualitative study with in-depth, semi-structured, one-on-one telephone interviews conducted and recorded between May and September 2019.

Participants: A purposive sample of 24 general internists practicing at 12 academic health centers in the USA: 14 self-identified as White and 10 as a physician of color, which included Asian, Black, Native American, and self-identified other race.

Approach: Four coders analyzed the transcribed and verified interview text; thematic analysis was used to inductively identify cohesive themes and subthemes.

Key Results: Analyses revealed four major themes: (1) assumption that a legitimate doctor is White, male, and able-bodied; (2) legacy of the Black experience; (3) working through the struggle of discrimination; and (4) ethical dilemma of providing care to discriminatory patients. In addition to discrimination from patients based on a physician's race or ethnicity, participants described experiencing or observing discrimination based on a physician's gender and disability status. Participants generally expressed a need for greater support from colleagues and more guidance from institutional policies.

Conclusions: General internists practicing in academic settings reported observing or experiencing discrimination from patients based on the physician's race, ethnicity, gender (or their intersection), and disability status and the ethical dilemma of providing care to such patients. These results contribute to growing evidence of the need for institutions to better support an increasingly diverse physician workforce with policies and specific guidance to help physicians respond to discrimination from patients while still providing quality care.