Mayo study shows doctor ID badges reduce unconscious bias
Name tag role identifiers are used to offset a phenomenon in which female physicians and doctors from underrepresented communities report being mistaken, including as nurses or cleaning staff, creating demoralization, burnout and impeding diversity in medicine.
ROCHESTER, Minn. — Physicians have been white and male for so long that re-training the public about diversity in medicine is going to require signage.
That's the takeaway from a new study in the journal Mayo Clinic Proceedings showing that a simple name tag that says "doctor" can greatly reduce demoralizing experiences of being misidentified as a nurse, cleaning person or other nonmedical staff — events commonly experienced by physicians who are female or from communities underrepresented in medicine.
"We started hearing about it more and more as we started increasing diversity in our program," said Dr. Amy S. Oxentenko, chair of the Department of Medicine at the Mayo Clinic in Arizona, and a coauthor of the study. "People being misidentified in terms of not being recognized as a physician in the room."
The study, conducted in the fall of 2019 at Mayo Clinic Hospital in Rochester, Minnesota, offered before-and-after surveys to more than 340 resident physicians, and ultimately measured findings from 159 residents in anesthesia, dermatology, internal medicine, neurosurgery, ear, nose & throat and neurology.
After surveying them, the authors surveyed the physicians a second time on their experiences of wearing the role identifier badges for eight weeks.
After wearing the badges, the number of female residents who reported weekly experiences of being overlooked by patients dropped from 81.8% to 18.2%.
The number of female physicians who reported that nonphysician team members had addressed them as something other than doctor dropped as well, from 57.6% to 13.6%.
Finally, the badges led to the number of female doctors reporting that doctors had misidentified them dropped from 31.8% to 6.1%.
Black doctors often are 'invisible'
Communities underrepresented in medicine also are frequently misidentified.
In a June 2020 essay, "The Invisibility of Black in White Spaces," Dr. Rebekah Fenton, a medical fellow at Ann & Robert H. Lurie Children's Hospital of Chicago, wrote of how she once sat interviewing a patient in the emergency department while wearing hospital scrubs and a badge.
According to Fenton, that's when "another provider busted into the room and announced 'Oh great! Family’s here!'"
"There was no resemblance between the patient and I," Fenton wrote, "we were just two people of color in the same room. Even if we did look alike, as a Black woman, I still didn’t look like a doctor."
To the contrary, Fenton wrote, "Black healthcare providers often report being referred to as family members or housekeeping."
In the Mayo study, after wearing the badges, physicians from underrepresented communities who reported being misidentified by patients dropped from 84.6% to 23.1%.
The reports by underrepresented doctors of being misidentified by nonphysician staff also dropped, from 46.2% to 15.4%. Finally, the reports by this segment of doctors of being misidentified by other doctors dropped from 23.1% to 15.4%.
The badges are seen as helpful not only for efforts at diversity, the authors say, but for easing patient confusion and embarrassment.
In a component of the study involving written comments, it reported a participant's recollection of how "an older gentleman" commented that, "I’m so glad you have a large sign that I can read!"
"I was so embarrassed when I was in the hospital a few months ago," the patient continued, "and called a young female doc my nurse! She earned that degree!'"
Oxentenko said a patient is often faced by a team of physicians of "any variety of gender and demographics ... and all of our name badges will just say MD, DO, MBBS or whatever that medical degree."
"The patient may not know what those degrees mean, or who is the doctor, so the patient may look to unconscious bias."
"Because medicine typically in the past has been a male predominant specialty, oftentimes they would look to the man in the team (when) it might be that the man on the team is actually the medical student, or the intern."
Ridicule in the OR
The study also noted the belief that badges will not work without universal participation, as 37 physicians reported experiencing ridicule from other team members — especially residents in surgical specialties.
“I was quite surprised at the negative comments from allied health staff," according to one female surgical participant quoted in the study.
"(Operating room) staff made jokes about the badges and (advanced practice nurses) made facetious remarks. It got to the point where I didn’t want to wear the badge anymore because everyone was making such a big deal about it.”