Swiss Healthcare Students Report Unequal Patient Care

Equal treatment is an integral part of professional healthcare standards. However, patients may experience differences in care related to their background, diagnosis, sex, age, or other characteristics. A recent study examined the forms of unequal treatment and discrimination observed by students during clinical training.Researchers defined bias as a conscious or unconscious preference for certain groups, and discrimination as behavior toward individuals resulting from that bias. Students’ perspectives were important because clinical training involved not only learning medical procedures but also observing how patients were treated and which behaviors were accepted within healthcare teams. These observations could shape students’ understanding of professional norms alongside formal instruction.In 2024, researchers invited 2176 bachelor’s and master’s students enrolled in nursing, physical therapy, occupational therapy, midwifery, health promotion, and prevention programs at the Zurich University of Applied Sciences in Winterthur, Switzerland, to complete an online survey. Of those invited, 470 participated, representing a response rate of 21.6%. Among the respondents, 422 answered whether they had observed healthcare professionals treating patients unequally, disparagingly, or discriminatorily. These 422 students represented 89.8% of the survey participants and 19.4% of all students invited.Of the 422 respondents, 210 (49.8%) reported witnessing at least one such incident. Eighty-eight said they had not witnessed any, while 124 were unsure whether what they had observed constituted a disadvantage or discrimination. Of the 210 students who reported such experiences, 182 provided further details in open-ended responses, which were qualitatively analyzed. Categories could overlap because individual responses could describe multiple behaviors or reasons for discrimination.However, these findings did not establish the prevalence of discriminatory behavior in the Swiss healthcare system. The study had a low response rate, involved students from only one university, and included many brief responses. In addition, the findings reflected students’ perceptions and did not establish whether the reported behavior was intentional or unintentional.When Care Was Inadequate or WithheldStudents most often described situations in which they perceived care to be inadequate or withheld. Fifty-eight reports were included in this category. Examples included delayed assistance, restricted access to pain medication, shortened or lower-quality treatment, and denial of care. In one case, a patient with severe pain had to wait for a prescription for pain medication because, according to the student, the staff had other things to do.One student reported that a patient from another country was initially denied pain medication because staff did not believe his complaints. The patient later reportedly required a high dose of opioids and was nearly sedated. In other cases, students described decisions being made without involving patients when language barriers arose.Students also reported instances in which patients’ needs were ignored by the staff. Fourteen responses described such behavior. Nine accounts involved physical mistreatment or coercion, including rough handling, holding a patient’s mouth shut, providing care against the patient’s will, and performing procedures without consent. Although these reports were uncommon, they illustrated the range of situations that the students considered problematic.Students reported derogatory language almost as often as inadequate care. Fifty-seven accounts described rude, disparaging, or stigmatizing remarks. In 23 cases, the remarks were directed at patients. Examples included verbal abuse, yelling, patronizing behavior, and speaking to patients as if they were children. Other derogatory remarks were made outside the patients’ direct presence.Students most often attributed the observed discrimination to ethnicity or foreign origin, with 48 accounts citing these factors. Several students reported that complaints from patients from other countries were taken less seriously. Some also cited terms such as “Mamma Mia syndrome” or “Mediterranean syndrome,” reflecting the stereotype that individuals from Mediterranean countries exaggerated their pain.Diagnosis was the second most commonly cited reason for discrimination, mentioned in 35 accounts. These reports most often concerned mental health conditions, substance use disorders, and dementia. Students also described instances in which patients with chronic pain, HIV, or incontinence were treated unprofessionally. Other reported reasons included gender and socioeconomic status (nine each), age (eight), disability (seven), sexual orientation (three), physical characteristics (two), and religion (one).When students could identify those involved, they most often described experienced healthcare professionals. Forty-five reports involved members of the healthcare team, and 14 involved supervisors or others in senior positions. No reports attributed the behavior to other students or interns. However, the survey did not specifically ask about the behavior of peers; therefore, this finding did not establish that such incidents never occurred. In 124 accounts, the individuals involved could not be clearly identified.The consequences were often unclear or not reported. In 161 responses, information about the consequences was missing or insufficient. When students described the consequences, they included avoidable pain, fear, humiliation, insecurity, and loss of trust. Some patients subsequently refused treatment or further communication.A few students also described their own reactions. They reported feeling uncomfortable or shocked, intervening in an incident, or reporting it. One student reported feeling pressured to justify their actions after they filed a report.Several respondents linked challenging situations to stress, staff shortages, time pressure, and fatigue. Patient behavior also played a role in some cases. Students reported that patients who clearly asserted their needs sometimes received more attention but were also perceived as difficult and, in their view, were treated less favorably.Learning Through ObservationRecognizing discriminatory behavior is not always straightforward. Of the 422 students who answered the survey question, 124 (29.4%) were unsure whether the situations they had witnessed constituted unfair treatment or discrimination. This uncertainty highlighted the difficulty in identifying problematic behavior in everyday clinical practice.The so-called “hidden curriculum” also plays an important role in this regard. Workplace culture, hierarchies, and role models convey norms and expectations that extend beyond formal instruction. Students learn about professional behavior not only in seminars but also by observing how experienced colleagues interact with patients and how healthcare teams respond to challenging situations.The authors recommended creating structured opportunities to discuss these issues, including debriefings, supervision, and ethics sessions. Faculty members and clinical instructors should be equipped to recognize discrimination and unconscious bias and adjust their behavior accordingly. They also recommended developing strategies to help students and staff intervene when they witness discriminatory behavior, along with clear procedures for reporting incidents. Those who report misconduct should be able to do so without facing additional pressure.This story was translated from Univadis Germany, part of the Medscape Professional Network.