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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 white and British but generally prefer to see foreign doctors as they are usually less pompous and are not tarnished with the same classist attitudes you frequently see in privately educated, middle class native British doctors (of whatever race).

    However I would never make a request to see a doctor based on this experience as it would be offensive.

    I've experienced a fair amount of discrimination from doctors (as a female) so I think discrimination is a two-way process.

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  • We had, temporarily, the only "all white" practice in the area. One day somebody rolled up & asked if we had white Drs & could they register if so...

    "No."

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  • i am a retired GP of Asian origin-my case scenario is different and that people from caucasian origin would wait to see me only 2/52+
    on audit we found that they had more confidence in me as i explained their problems on empowerment slides.So its absolutely right to explore the reasons of such comments and improve the confidence

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  • this is certainly fraught with problems - some patients have limited socialisation and may be saying what their parents say, not what they hold strongly to. I remember inappropriate remarks in the pub excused by "present company excepted" as he was happily buying drinks for, and receiving from, a rainbow of mates.
    It's entirely appropriate that someone should ask to be seen by a doctor who understands their cultural (or even gender) background. The rub here is that probably every doctor who works in UK does understand the white working class or middle class background, so the time when you can ask is when your background is culturally a minority.
    I suspect the right answer for a first offender is to decide how urgent the requirement is, and either book them in to see a GP as requested (if it's urgent), or advise them that the Practice Manager will call them back (if it isn't). Then the GP or practice manager can take a bit longer to make a proper assessment, and decide if their expressed attitude can be changed or if they don't fit with the practice. If the latter, then I would consider reporting racist attitudes to the police (with the patient's knowledge, of course).
    Remember, a doctor should not withhold care from anyone who needs it (where "need" may depend on urgency).

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  • I have had anxieties re seeing non white doctors, often due to not being able to understand them, no more than that!
    I changed GP's for other reasons, now having only two male GP's from Sri Lanka, they are fabulous and dare I say it, better than some white doctors I have dealt with.
    In this case, I would arrange a meeting with the patient and some of the non white doctors at the practice to allow her to se that they are very nice professional folk and she has nothing to fear,
    Often the cause of these type of problems are due to the unknown.

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  • This comment has been moderated.

  • We had this very issue this week. A request for a home visit punctuated with I want a white doctor only. Reception was horrified however we did send a white doctor and I sent a strong letter saying we would not guarantee to this request in the future and that you would be seen by the doctor on call whoever that may be. If that was not satisfactory then it maybe an idea to move practtices

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  • Ive dealt with this garbage before. As a British born asian GP in 2011 i was on call and told by a patients family requesting a home visit that the patient "didnt want an asian doctor!!" now in the practice at the time (which happened to be in a 90% white area) half of the staff of 12 doctors happened to be asian. I really couldnt be bothered to raise an issue out of it and made sure one of my clearly more competent white colleagues visited this patient.

    Its funny looking back now, another time a cantankerous old patient once told me "to get on a bloody banana boat and go back to where i came from!!!" to which i replied "i come from here sir and there are not any rivers near my house"!

    oh dear how i miss the little englanders!!

    thankfully ive taken my hard earned skills and moved abroad and enriched myself considerably! gosh how i miss my old patients

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  • I get patients who say they only want to see a coloured GP
    What to do?

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  • You do not get any choice what colour your police officer is
    So why with a Doctor
    Your choice is ...
    Take it or leave it

    Rasism againt ones own kind also exists
    Something cultural
    Same race can be too familiar
    Coloured patient may refuse to see a coloured or same origin doc

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  • Most patients are actually very appreciative to see a competent fluent doctor
    GP's are getting rarer and rarer

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