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Independents' Day

The label of racism in UK medicine is not helping discourse

Blaming institutional racism for poor regulatory outcomes for doctors from ethnic minorities is too simplistic, argues Dr Neel Sharma

The case of Dr Hadiza Bawa Garba, and more recently evidence highlighting revalidation deferral among BME doctors, following on from reports of the ‘snowy white peaks’ of the NHS and the higher level of complaints against minority ethnic doctors, has led to UK medical institutions being given the label of racism.

Yet whilst evidence may be continuing to emerge to suggest disparities in how BME doctors fare, it does little to help understand the issue in depth.

As an Indian born in the UK, I would rather we enter into more searching discourse as to why these disparities arise. My upbringing thus far has led me on a journey of significant diversity. Many of my friends at school were Jewish. I knew the importance of Friday (Sabbath) to my Jewish friends – I was not allowed to call or see them and eagerly awaited Saturday to socialise. I recently attended thanksgiving in the US with a Jewish family, and my last research sabbatical was at a Jewish medical school. Similarly, I had many friends with Chinese heritage at school and I understood their culture early on too. So living in East Asia for four years felt completely natural to me.

As Asians in the UK we have to understand that each country is run in a certain way. The ‘stiff upper lip’ is something I don’t understand at times, in fact it makes me nervous and I often enjoy the flexible, animated can-do attitude of the US. But every nation operates a certain way. Is medical regulation in the UK truly at fault? In light of recent events, many have argued so. But maybe regulatory processes ensure continued rigour that we may not see in less developed nations. I recently successfully revalidated as a minority and while I have questioned previously the long term value of this process, the process of licensure maintenance in the UK is such. Similarly, whilst maintaining a licence in Singapore I abided by the local regulatory processes.

This country is now highly diverse and for my generation growing up in such diversity was normal

For those that migrate to the UK or are minorities born here, the culture is still very much British. We shouldn’t expect to change it. But what we can try to change is our understanding of one another. Do we hold a perception or affinity bias? And, if so, how can we rewire our thinking? As Asians do we lament the days of colonisation and should we continue to hold the UK to account for the many travesties that occurred? Maybe that is part of our frustration and rightly so. Should the UK be critiqued for its continued colonial mentality? For example, we still choose to export our educational models abroad and fail to allow developing nations to build their own. And we recruit candidates from abroad who bear the brunt of great educational expense knowing the likelihood of them being employed long term is minimal.

Is it a generational issue? In view of Brexit and the desire for Britain to be ‘Great again’ maybe so. This country is now highly diverse and for my generation growing up in such diversity was normal. For those who are older it may be difficult to adjust to. They may feel as foreigners in their own country. It has been suggested BME doctors are more likely to face investigation by the GMC. Could this be due to the public at large holding ingrained biases? If so, this in turn could lead to a higher referral rate and hence investigation by default. The regulator states that it functions to protect patients, after all.

A label of racism as a default is not the way to go. I could myself claim racism every time I failed to succeed. And I have failed many times, be it to get jobs, succeed in exams or obtain research funding. Was that racism at play, or just not being of the required UK standard at that time? I believe in the latter.

I believe that as doctors who care for a diverse population, we have no place in the profession we are in if we are harbouring a prejudiced mind-set. We as doctors may hold all the degrees, positions and titles we wish. But that does not garner life-long respect. Being simply book smart is not necessarily street smart. If we lack real life exposure, a desire for humanism and a willingness to understand each other, nothing will ever change.

Dr Neel Sharma is an academic clinical lecturer in gastroenterology at University Hospitals Birmingham NHS Foundation Trust

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Readers' comments (7)

  • But if your GP Tutors and colleagues in retirement age tug at your clothing while you are up in a GP Meeting expressing an opinion, telling you to sit down 'because your colour is not right' - it goes a long way in telling of a whole generation of mind set which has burnt from within for decades. The fear ingrained in those wise grey heads beggars an explanation. Are we getting out of that or sinking deeper?

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  • I'm sorry, but these are very outdated arguments.

    "All you migrants out there must assimilate and abide by the rules of Britishness, rather than changing the culture of Britain."

    Of course it's multi-factorial and complex. But much of it is unconscious bias and that is subtle and often overlooked.

    If you have any system - be it an exam or a disciplinary process- where there are such disparate outcomes regarding race, you have to scrutinise that system's processes.

    And medicine is one of the last bastions of an old boy's network.

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  • Did you know that a diagnosis of 'Gastroenteritis' in a child with Vomiting and Diarrhea for over 12 hours, was stated to be 'negligent' by the expert witness in the case you cite and then changed to ' misdiagnosis'What would your diagnosis have been ? Not one gastroenterologist I have seen has remarked on this.

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  • You actually have made no attempt whatsoever to address the ongoing truth about the higher complaint and failure rate amongst BME doctors! With all do respect telling us about your upbringing and various culture encounters has nothing to do with the problems the BME doctors face. Yes yes your horizon is “broad” but I find it offensive that you even imply that when BME doctors fail we blame the system rather than take accountability! “ label of racism as a default is not the way to go. I could myself claim racism every time I failed to succeed. And I have failed many times, be it to get jobs, succeed in exams or obtain research funding. Was that racism at play, or just not being of the required UK standard at that time? I believe in the latter.”
    Wow !
    The issue is multidimensional and sadly this article has over simplified it without taking into consideration the actual real issues we face.
    I suggest you “diversify” out a little bit harder to see the real problem , starting from the institutions to the the public outlook to the organisation we work for.

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  • Have we become too much part of the establishment Dr Sharma? Affinity bias..I like that, much better word than racism. I am Britsh naturalised Indian trained Doctor. I have never faced overt racism and so have accepted and succeeded despite the subliminal discrimination from the time I stepped foot on these shores. No hard feelings on my part , this is part of the deal. But please let's not pretend that discrimination does not exist, as highlighted by Bawa-GArba. The NHS and GMC are extracrptive institutions as far as foreign doctors are concernedthat just about have their heads above water on account of imported labour. I think I maybe part of the establishment now, but no getting away from the truth. No need to obfuscate.

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  • I would strongly agree, but then presumably I am a racist now.....

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  • AlanAlmond

    I completely agree too, sensible and open

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