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Independents' Day

A patient won’t see a ‘non-white’ GP

Three experts advise a GP facing a potentially racist patient

A patient asks for an appointment, but when told which GP they are seeing, they say they won’t accept a ‘non-white’ GP. What should we do at the practice?

Dr Pipin Singh

Dr Pipin Singh: Consider if it warrants action against the patient

It is important to have a protocol for situations like this. A receptionist facing this should probably provide the patient with an alternative doctor as they are likely to be busy. However, they should also refer the situation to the practice manager.

It would be useful for one of the doctors or the practice manager to explore why the patient does not wish to see that particular doctor. It is important to remain non-judgmental. You may be able to delicately challenge any ideas the patient has and change their views.

If this proves unsuccessful, you must decide how serious the comments have been or investigate whether this has happened before. If it has, this may warrant immediate removal from your list. Send a letter explaining the specific behaviour and an explanation that you have a zero tolerance attitude, citing the Race Relations Act to support this.

If there have been no prior issues then a written warning would be acceptable. This would explain that the incident has made the GPs and staff very uncomfortable. It would also be worth signposting the patient to NHS England statements from the Equality and Diversity Council, stating ‘employees from black and minority ethnic backgrounds have equal access to receive fair treatment in the workplace’, and stating that if this sort of behaviour is displayed again it will lead to immediate removal.

Dr Pipin Singh is a GP in Wallsend, Tyne and Wear

Dr Trevor Thompson

Dr Trevor Thompson: Don’t jump to conclusions

Let’s assume the initial call was taken by a receptionist and passed to me for action. Despite initial annoyance, it’s important that I park my reactivity and find out what is going on. The ethical tension here sits between my desire to respect patient choice and the wrongness of making that choice on grounds of race.

After a quick look at the caller’s notes – to check if it is a recurrent problem and whether they might have serious mental illness – I’d call the patient and explore. Perhaps they don’t want to see a certain GP because of past issues. If so, I’m more at ease because the race angle is probably incidental – a badly played attempt at identification.

In the recent past the NHS has benefited from the services of non-UK trained doctors from Asia and Africa, some of whom have been perceived to have imperfect English, strong accents and cultural distance. If I picked up this perspective I’d explain all our doctors are perfect English speakers. This is the flipside of the many patients who seek out my partner who is fluent in Kurdish. People yearn for that cultural recognition. Conversely the caller might themselves be from an ethnic minority and worry about being judged.

If the caller pursued purely race-based ‘reasoning’ I would remind them that the backgrounds of all doctors are published on the practice website and explain that such requests are disrespectful and possibly outside the law (Equality Act 2010). If they softened, I would actively encourage them into a consulting situation where they might learn that skill and compassion are colour blind.

Dr Trevor Thompson is a GP in Bristol and reader in healthcare education, University of Bristol

Dr Mohammed Saqib Anwar

Dr Mohammed Saqib Anwar: Seek help from family members

While the most obvious response may be to refuse such a request, it is important to consider the issues fully. Respect for patient autonomy is one of the most important principles of medical ethics. The GMC in Good Medical Practice states that: ‘You must respect a competent patient’s decision to refuse an investigation or treatment, even if you think their decision is wrong or irrational’. But does this include refusing an unwanted doctor? Here are some points to consider.

What is the patient’s medical condition? In an emergency with a patient whose condition is unstable, the refused doctor could quite properly stabilise the patient. What are the reasons for the request?

Patients may refuse a particular doctor because of bad experiences. The patient may have had a negative personal experience with people of a particular race or ethnic group (such as a veteran with post-traumatic stress disorder who refuses treatment from a clinician of the same ethnic background as former enemy soldiers, or a woman who has been exploited by males of a particular race). You need to understand why they don’t want to see that GP rather than simply assume is down to racism.

What are the options for responding to the request? For example, could you use family members to help patients accept the doctor? Are any other doctors available? Would it be appropriate for them to wait to see someone else?

I think it is helpful for doctors to consider these factors and possibly seek advice from their medical defence organisation before deciding how to proceed.

If the situation and circumstances allow I think the doctor being rejected could explore these issues themselves, but failing that I would delegate the job to the practice manager, given the sensitive nature. It may be that further discussion is required or the request might be accommodated given the clinical situation.

Dr Mohammed Saqib Anwar is medical secretary of Leicester, Leicestershire and Rutland LMC and a GP in Oadby

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Readers' comments (48)

  • I am an "ethnic" doctor, practising in a 76% white area for 24 years. We never had such a request in our practice. It is a good topic for an academic discussion but to make a big issue out of it is ridiculous and counterproductive.
    Should we however come across such a request, we would check the patient's mental capacity.

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  • I disagree GP Partner 10:40am. We have had patients making unacceptable comments/refuse to see doctors purely on account of their race.
    Sweeping these issues under the carpet as happens frequently in the NHS will not make the problem going away.
    Being a patient is not a licence that permits racist behaviour. We have laws in this country against racism and they apply to all people.

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  • @GP Partner 18 Oct 2016 10:40am
    I am a British born asian doctor who worked in a 90% white area for one year and found myself singled out by a patient who "didn't want to see a brown doctor' because of a previous bad experience with an asian doctor. My practice had no established policy for this and this led to problems for the team in not knowing how and where to draw the line around such behaviour. This lead to my feeling extremely isolated while my colleagues all looked and acted like rabbits in the headlights.
    Don't let you hitherto charmed life (in this regard) fool you, this is not an academic discussion, but a serious issue for may GPs which needs exploring before the problem presents itself at reception.

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  • i worked as single handed gp for 30+ years in area where 99% are white. it is not only colour but gender where patient asked for female doctor.
    white doctor was not an option. female who did not wish to be examined by male doctor where it was necessary were told to find another practice or to allow it to be included in medical record of refusal to be examined.

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  • I am a white male GP born outside the UK. It is extremely rare for me to receive a racist or other derogatory comment referring to my ethnicity- and this is only true about interactions with all sorts of people at work. Outside work my professional status does not offer any protection. It is rare for a doctor to find themselves in such situation, but I am afraid those immigrants who are less fortunate, and don't have same opportunities and social status that being a doctor offers, face casual racism on a daily basis. For once I agree with studies of social behavior that all indicate that racism is alive and well in the UK, its just that having higher social status protects us from some uncomfortable truths.

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  • "You are welcome to register at a practice solely staffed by white staff if you want. We cannot distinguish betweeen our colleagues on the basis of race. Have a nice day."

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  • We should respect the patients wishes and direct her to other practices that can meet her requests.

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  • Keep it simple. Mental health problems are not an excuse for racism. Strike off from the list

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  • Just confirming that I am a black of Caribbean origin working in a predominantly Caucasian area. The issue of race has come up very frequently, and I was once turned away from a home visit because the patient did not want a black doctor.

    Recently, a lady screamed when she entered the consultation room on seeing that Iwas black. I continued to deal politely and professionally and did not comment that her scream was frightening for me. She called someone on her mobile phone and told them that she found me to be very helpful and very good, but she is going to still complain because she had especially asked to see a white doctor only. I did not engage in the banter at all. But to be fair I was new at the practice, and to be fair the Reception staff did not know I was black, because my surname is European (most Caribbean surnames ard European).
    Racial discrimination is normal in the UK, and much more common than people want to admit. I don't engage in banter, I just carry out my job professionally.

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  • I've had a Psychiatrist write to me to 'organize a white British doctor' for a mental health patient who did not want a coloured GP. I did not reply because I did not feel my response would be received well.
    MH patient - I'll excuse that once, but looking at the wider picture, even funding per patient for a coloured GP is less than for a white colleague. Check it out in Medway because nobody will ever give you that information. My predecessor was paid more for one 2/3 of my list size in 2007- you don't need proof for these things because you won't get info from the authorities. BTW there is no coloured Manager in NHSE in Kent and Medway.
    We are talking about patients - people who are ill and can be having a bad day or frustrated with pain. The white collar community is worse because it can even chase and bully away an ethnic Medical Director who moaned about this a few years ago on the BBC saying that from day one he was hounded by the authorities till he resigned from his post in Medway Hospital.

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