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A faulty production line

I am a BME doctor and I worry about my future in the NHS

Dr Punam Krishan

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As a doctor working in the NHS, I have always believed that I was protected. I live in a nation that advocates fairness and equality. Ahead of the world, we represent diversity. We are lawful and welcoming to all walks of life… or are we?Recent developments within our medical community have sent shivers down our spines. Our states of mind shaken, our stomachs lurching with anxiety inducing a painful insomnia as we ruminate over our fate.

Born and brought up in Scotland, this is my home. The colour of my skin is brown which when paired with a distinctive Glaswegian accent tends to generate some curiosity in the minds of my patients. A question I’ve sometimes been asked is: ‘Where are you from, doctor?’ My reply of ‘Glasgow’ is seldom sufficient and is usually followed by, ‘but where are you actually from?’ This question does not offend me because curiosity is intuitive and should be welcomed. If I can know personal things about my patients, it’s only fair they can know a bit about me.

It is, however, when curiosity becomes an interrogation, either in consultation or in the form of a complaint that I begin to feel a helpless panic come over me. The ‘coloured doctor’, as I have sometimes been referred to, is demeaning.

Experiencing racism from patients does not compare to the fear institutional racism generates within us

Amongst all the pressures faced by doctors in the UK today, racism – both covert and overt – is an additional stressor that black and minority ethnic (BME) doctors face on a daily basis.

But I must admit, as unnerving as it is to experience racism from patients, it does not compare to the level of fear institutional racism generates within us.

Around 30% of our NHS workforce has a BME background. This is not an insignificant number. We encourage the uptake of foreign doctors to help fill gaps in our grossly understaffed NHS, yet many happily turn a blind eye when these doctors face racial abuse, bullying, scapegoating and indeed criminalisation of their work.

In light of the case of Dr Bawa-Garba and reviewing the published data, I learnt that BME doctors are far more likely to get public warnings and restrictions to practice compared with their Caucasian counterparts. Thankfully I have never had to face a GMC investigation and, until now, I never doubted that the GMC could ever be anything other than fair.

However, as an Asian doctor, I now quiver at the realisation that our professional governing body apparently deems BME doctors to be less able and more culpable compared with Caucasian doctors when judging clinical errors and complaints.

It is widely recognised that outcomes of medical recruitment, exams and applications to specialties are more favourable for white than BME applicants. Forget the data, one simply needs to look at those in positions of influence in both undergraduate and postgraduate boards in medicine and we can see how embarrassingly misrepresented it is.

If as a British-born Indian doctor I feel like this, it makes me sick to think how those who have left their native countries to come and work tirelessly for our NHS must feel. For most such doctors, English is not their first language, and many have an accent. Western culture may be wildly different to what they know. They get judged for this, when it is their knowledge and expertise that should be judged and not how they dress, talk or act in a social setting.

In a time where travelling is the modern-day hobby, we travel the world to learn about cultural diversity, yet when doctors from such cultures come and work with us, institutional racism is shamefully letting them down.

For BME doctors, rejection by patients, colleagues and governing bodies due to racism and bigotry is contributing cumulatively to moral distress and clinical burnout.

I believe this is reversible if we start addressing it now. Let us all work together for the sake of our profession. Let us all work together without any judgement and let us all lead by example to create a tribe of incredible doctors and nurses who support and respect one another.

We are in a profession where we can influence society. Let us not give the media and public more ammunition because our work will always remain grounds for criticism and litigation.

Those at the top, the ‘snowy white peaks of the NHS’ and the GMC, need to recognise that the global climate is changing. It is time for drastic measures to be put in place to address institutional racism as a contributing factor to punishing doctors unfairly. Otherwise an avalanche will come down and bury the NHS and them with it.

Dr Punam Krishan is a GP in Glasgow


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Readers' comments (17)

  • Why do "Blacks" get a solo billing in the "BME" designation? And, unless you have a dermal chromatograph handy, what actually is the definition of "black"? Really, I am not trying to be obtuse, but identity politics is a depressing vortex to hell (or the undergraduate backroom where the Judean Popular People's Front are still arguing amongst themselves)

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  • Probably more of a depressing vortex to hell if you're actually a doctor affected by the discrimination associated with identity politics though eh? If the affected group have co-opted the term on an institutional level, identify with it and use it as a heading under which to fight their corner, probably best to respect that, stop quibbling over pedantry and actually listen to the issues at hand?
    (DOI: Glasgow based, never met Dr. Krishan)

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  • Excellent article, Punam

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  • Great article! I am a British Born Asian doctor and many of my friends in hospital and Gp surgeries have been very worried.

    A lot of us are just worried about the one complaint that will lead us to the end of our careers and just hope it will be in the latter stages of our lives and not now.

    This has been very allarent right from applying to medical school, grades in OSCEs or on placements. My dad always said you have to work twice as hard which is fine - but if you get done that that could be it

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  • Gutsy article - saying all that most BME doctors have wanted to express all their lives.

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  • Cobblers

    Good article Punam. If I may quote:

    "Around 30% of our NHS workforce has a BME background."

    Hmmmmm. Anyone looked at the (GMC) MPTS website?

    Does the list comprise 30% BME doctors is all else were equal? Or is it more 80-90%?

    Why is this tolerated?

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  • AlanAlmond

    I think everybody is worried, white people as well. I guess if you identify as BME you’ve got a convenient box to put yourself in and a way of defining the problem that divides you from the people on the others of the cardboard. Racism is a terrible scourge, not least because it can put barriers up between you other others who share your concerns. Life for a Dr in the UK isn’t rosey just because your skin is pale, believe me.

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  • Would be grateful if ‘snowy white peaks’ could be clarified. I’m Pale Male and Stale - I believe through no fault of my own - so I’m a minority in GP as there are more females 51:49%! I take on the ‘what is black’ argument and can’t help bring up the ‘tar brush’ / what makes the greatest president of our generation a ‘black man’ - it can only be that it suits some arguments - he’s a middle class child of a white mother is he not?

    Let’s get away from BME / Pale Male & Stale / Tinted Female & Fresh.

    To me young enthusiastic GPs (especially those with a portfolio and ability to communicate well) are the future - gender, accent and heritage or sexuality matter little to me but putting in at least as much as you get out and recognising the team is key - (please don’t confuse portfolio career with working term time only and finishing at 4pm for the School run.)

    You identify yourself as Asian and British Indian do shy get upset when others do also ‘coloured’ is old fashioned and may have been prefixed or suffixed by lady : pretty : young etc Get over yourself and if it matters enough define yourself and put out there how you wish to be described when patients can’t remember your name. (I’m the grumpy old GP in room 2 as opposed to the young Male GP, the 2 lady GPs one with long hair the other not and the New or ‘foreign’ Dr upstairs - amongst other descriptions
    My daughters want one of those heritage DNA tests - the look Nordic but aspire to some rather more exotic connection - would it be a good thing or not?

    If the young talented, tinted and LGBTQI or even H want change at the top then THEY need to step up - Many of us are more than willing to help but the idea that those at the top need to step aside is unrealistic and patently unfair. The power is in YOUR hands - step up and you’ll find that as we pm&s fade away there will be a space for you to step into should you want it.

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  • We should stop as a profession and as a nation of looking the other way. Truth can be unpleasant but as we tell our patients sometimes has to be faced courageously. The GMC hearing statistics and the MPTS decisions show that BME doctors are overrepresented in these. Certainly more than 30% !!
    Is the BMA going to do anything about it. Is the government listening. If not how do you get them too...

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  • Punam we need leaders like you

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