Patient Initiated Discrimination and Harassment-A Descriptive Survey of Experiences Within a Single Academic Department.

Background: Diversity in orthopedics is lacking despite ongoing efforts to create a more inclusive workforce. Increasing diversity necessitates recruitment and retainment of underrepresented providers, which involves representation among leadership, mentorship initiatives, and development of a safe work environment. Discrimination and harassment behaviors are prevalent within orthopedics. Current initiatives aim to address these behaviors among peers and supervising physicians, but patients are an additional underrecognized source of these negative workplace behaviors. This report aims to establish the prevalence of patient-initiated discrimination and harassment within a single academic orthopedic department and establish methods to reduce these behaviors in the workplace. Methods: An internet-based survey was designed using the Qualtrics platform. The survey was distributed to all employees of a single academic orthopedic department including nursing staff, clerks, advanced practice providers, research staff, residents/fellows, and staff physicians. Survey was distributed on two occasions between May and June of 2021. The survey collected information on respondent demographics, experience with patient-initiated discrimination/harassment, and opinions regarding possible intervention methods. Fisher exact test was used for statistical analysis. Results: Over one half of survey respondents report observing or personally experiencing patient-initiated discrimination within our orthopedics department (57%, n=110). Nearly half of respondents report observing or personally experiencing patient-initiated harassment within our department (46%, n=80). Encounters with these behaviors were more commonly reported from resident and staff female physicians. The most frequently reported negative patient-initiated behaviors include gender discrimination and sexual harassment. Discordance exists regarding optimal methods to address these behaviors, but one third of respondents indicate potential benefit from visual aids throughout the department. Conclusion: Discrimination and harassment behaviors is common within orthopedics, and patients are a significant source of this negative workplace behavior. Identification of this subset of negative behaviors will allow us to provide patient education and provider response tools for the protection of orthopedic staff members. Ideally, minimizing discrimination/harassment behaviors within our field will help create a more inclusive workplace environment and allow continued recruitment of diverse candidates into our field.