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At the heart of general practice since 1960

How you can drive out racism in practice

Don't tolerate patients' racist comments in your surgery ­ Dr Paul Siggins shows how to meet the problem head on

am a singlehanded, white GP and I work in the East End of London. My patient list of 3,000 is 90 per cent white. All my staff are white. I was brought up in a town in Essex, which celebrated its first black policeman in the 1960s with press fanfares. My secondary school had an entirely white teaching staff and just one Indian pupil.

When I came to London in the 1970s the entire consultant staff of my teaching hospital were white, and 90 per cent of my student colleagues were white.

But times have changed. Nowadays that same teaching hospital has a consultant staff list that reads like a list of delegates at the United Nations, and at local clinical meetings my white face is always in the minority. So in medicine at least, it seems we are becoming racially more mixed and, with luck, more tolerant.

But what about our patients? Just 300 yards from my practice is the practice of an Asian colleague. He is also singlehanded, and he also has about 3,000 patients. The difference is that 90 per cent of his patients are non-white.

Both our practices have been established on their current sites for more than 30 years, and the doctor here has always been white, the doctor there never so.

I promise you I never pick and choose patients, and our practice areas are near as can be the same. So how has this come about?

I can't explain it purely in geographical terms, even though this area of London does have pockets of almost single-race streets.

Could it be his ability to speak a language other than English? That may be part of it.

But why is it that the vast majority of refugees who have registered with me have been white Eastern Europeans? And why have his refugee patients been African in the main? Why have I recently registered large numbers of white South Africans and Zimbabweans?

Perhaps my conclusion isn't so earthshattering. Our patients are racist!

Before the hate mail starts arriving, followed hot-foot by the News of the World, I want to set you a test.

You are walking in the street and you see a couple holding hands, obviously much in love. They stop for him to peck her on the cheek and they giggle at a secret joke.

The next bit is the test. If you are white, let's make her white and blonde, he a dreadlocked Afro-Caribbean. If you are Asian, let's make her a petite raven-haired Indian, he a tall fair white boy. It doesn't matter which combination of 'colours' you choose as long as one is your own and the other is different.

Now if your very first reaction is 'What a lovely couple!' then well done, you definitely can't be racist.

Have you still got the image in your mind? Good. Now imagine one of them is your son or daughter.

I may be entirely wrong, but I'm betting a fair number of you have just thought or felt the mental equivalent of 'Ulp!'.

I'm betting that the very next thought, because doctors are intelligent, rational people, could be summed up as 'but they look very happy'.

Was the 'Ulp' a racist reaction? I'm not sure that it was. It may be partly that, but it may partly be a reaction based on 'difference', which is pretty much

instinctive. Indeed, I would go so far

as to suggest it might even be normal.

So now put yourself in the position of our two patient groups, and this type of 'instinctive xenophobia' could easily explain the diversity in our two practices and to be honest I don't have any suggestions how this could possibly be changed.

But there are things we can change. I don't doubt that any patient making a racist rant in the practice directed at doctor, staff or other patients would be ruled completely out of order. I personally wouldn't feel able to see them again.

But what about the patient whose consultation at the out-of-hours centre or hospital has not met their expectation, and who says something like 'Well, you know these (insert a nationality) doctors....'.

It is easy to let this sort of low-level racism slip by without protest, with just a mumble on your part that could be construed as you agreeing. Don't let this happen. Fix the patient with your very best 'college' eye contact. Tell them: 'Dr X is a valued friend and colleague, he will be upset when I tell him how you feel.'

If we all do this consistently, you never know, one day a racist patient may see that doctors of all colours stick together and help each other. That patient may learn something.

A little postscript. The two practices mentioned above are shortly to become one, at new shared premises. Both doctors are looking forward to it greatly.

If a patient made a racist rant in my practice I wouldn't feel able to see them again~

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