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GPs go forth

The sinister parallels between the NHS and the airline industry

Dr Kamal Sidhu

Parallels are often drawn between the airline industry and the NHS, but there appears to be another rather sad comparison between the two.

Recently, a surgeon colleague and his family were deboarded from a flight. This occurred after he got up to settle his one-year-old daughter, with the plane still attached to the gate, because he objected to the crew’s rude behaviour.

This colleague strongly believes that there is no reason for this extreme high-handed action, which nearly branded his family as criminals, other than the different skin colour and that this colleague wears a turban.

Such extreme incidents are rare, though the scale of the problem is much bigger. The differential behaviour ranges from being ‘randomly’ selected for security checks, to being served differently, from being asked to wait unnecessarily for boarding under flimsy pretexts, to being spoken to rudely or threatened to be deboarded or reported under the pretence of safety. These appear not that uncommon, and I personally have been at the receiving end of them too, including being randomly selected for security checks.

One airline changed its policy after it emerged that a BME doctor’s offer to assist in a medical situation was turned down by the crew. Images of a doctor being dragged from an overbooked flight in 2017 stand testimony, too.

The problem is so widespread that the National Association for the Advancement of Colored People, the oldest and largest non-partisan body of civil rights in the United States, accused the airline industry of racism. It pointed out ‘a corporate culture of racial insensitivity and possible racial bias’ within the largest American airline.

Such incidents are likely to be the tip of an iceberg and aren’t uncommon within the UK, either. Rather, there are so many anecdotal experiences, from what I have heard, just from the BME medical community itself.

A very closed environment, little or no answerability from the authorities to the public, and the pretence of safety or security essentially leaves anyone helpless and unable to challenge decisions. It would seem that the ‘zero tolerance’ policy that exists to protect the staff and for overall safety is often used and potentially abused.

The world is hardly confined and defined by boundaries anymore… these industries continue to let so many subsets of people down

Though the concept of professionalism is shared between healthcare and the aviation industry, it would seem that attributes of the inherent biases and prejudices are also commonalities.

It’s clear that racism is rife across society, with its tumultuous political narrative, the rise of far-right ideology and a significant increase in reports of racist behaviour.

In the NHS, we often talk about discrimination and institutional racism in the context of ’snowy white peaks’, i.e. a lack of non-white representation in leadership positions in the NHS. A recent report suggested that out of the 76 positions within STPs and ICSs, only one has a lead with a BME background. This is about 1% representation, when the BME represents about 30% of the doctors alone.

The data suggest that disparity in performance starts right at the university level, resulting in an attainment gap during the graduate years and at the time of recruitment, and continues through membership examinations. This means huge disadvantage to BME doctors during their careers.

Moreover, BME doctors are less likely to be offered GP training places, while BME international graduates are almost 15 times more likely to fail the CSA on their first attempt, and BME UK graduates are 3.5 times likelier to fail than their white colleagues. The scenario is so appalling that the differences are also seen in form of a pay gap based on ethnicity, where the median basic pay for white consultants is 4.9% higher than for BME consultants, despite the same work being conducted.

Additionally, Pulse previously pointed out that BME GP partners are over-represented within practices rated as inadequate by the CQC. After decades of being aware of the fact that BME doctors are not only more likely to be reported to the GMC, but also to be investigated and to receive sanctions including erasure, it’s just now instituted yet another review.

I fear this will become nothing more than a tick-box exercise, and that future generations will have the same debate. The fact remains that a male international medical graduate is likelier to fail multiple times in membership examinations, work in deprived areas and have suboptimal career progression, whilst a white male UK graduate is more than likely to be the leader of your CCG or trust, and thrive in the process. It’s often felt, and in fact vocalised, that BME graduates have to perform at a much higher level to attain the same achievements as white counterparts.

All in all, it appears that the striking similarities in the treatment of the BME community, be it the NHS or the airline industry, are tellingly shocking. If there is anything to learn, the message is indeed very simple. We have to unlearn a lot of our prejudices and start afresh, with the whole of humanity recognised as one race.

Specifically, the NHS and the airline industry, and more generally, wider society, must be more open and fairer to all. The world is hardly confined and defined by boundaries anymore. There really is a need to learn from each-other, concerning the two industries and why they continue to let so many subsets of people down.

The very least we can do is to stand up against racism. As American author and activist Angela Davis once said, ‘In a racist society, it is not enough to be non-racist. We must be anti-racist’.

Dr Kamal Sidhu is a GP and trainer in Durham, vice chair of County Durham and Darlington LMC and chair of South Durham Health CIC. He writes in a personal capacity.

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Readers' comments (10)

  • DrRubbishBin

    Are you aware of the concept of confirmation bias?

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  • @ MonkeyTyping | Locum GP20 Aug 2019 3:42pm

    ‘Are you aware of the concept of confirmation bias?’

    That is indeed an interesting and important concept that probably deserves more consideration in most judgements. Does it for instance, explain the disparity in the demographics of the CSA results? To memory, even the court wasn’t impressed with the explanation given? If there is a slightly sour taste in some quarters over that issue, it’s hardly surprising!

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  • I've been selected for random security checks plenty of times and I am a white, old, female.
    My husband and kids all get these too. The plane won't move until everyone is strapped in and if he was either holding up embarkation or holding up the taxi to the runway then the flight could have missed their slot. This would lead to a whole array of knock on effects. Maybe the crew had a point.

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  • I think as travellers on airlines we all understand that katherine, however there is no need to be dealt with rudely by anybody. For someone to have to object. It may have been racism at the time or maybe not, just saying that the statistics are deeply concerning. It would be great if we could hear the stewards point of view and also look to see everytime that they had spoken harshly to look for trends in behaviour.

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  • Dr Kamal Sidhu is a GP and trainer in Durham, vice chair of County Durham and Darlington LMC and chair of South Durham Health CIC.- Mmm seems to have risen to the snowy peak himself!

    When I get picked out for a ‘random security check’ I think of it as ‘random’ - that some others with more melanin think that their randomness is racist is anecdotal. One surgeon, one flight does not racism make. This was a ‘safety’ issue and related to getting the plane off in its slot. Rudeness is unfortunate but happens to us all and is not an excuse for breaking the rules - no matter how ‘right’ you feel you are. It’s their rules - break them and take the consequences like the rest of us

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  • I told my better half not to take my surname when we got married. She is white and English for many generations. Now she gets discriminated against and she even has people speak slowly and very loud to her when they see/hear her surname. She no longer laughs at me when I tell her racism is rife.

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  • Racism is more common in societies where people are not happy with their own lives. Psychological problems are so common in western in western world. These are reflected in their personal lives in the form of racism. Unfortunately foreigners are soft targets. I have travelled throughout the world and did not come across in countries where people are happier with their own lives and found them very welcoming.

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  • I fully agree with Mohammad Arif, racism is high in countries where the public is unhappy.

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  • Does that also then explain why racism is rife in the BME community?
    The most objectionably racist people I knew from school were from one origin that had much darker skin than I myself have! They hated anyone who was not from their own group, and openly.

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  • Been debating whether to comment but to shy away from calling out BS would be cowardice...

    1. Do your research. 4 passengers randomly selected. 1 refused to leave despite UA having the right to remove overbooked passengers in the terms of booking. Airport security staff were the ones to attempt to remove him, and his injuries were the result of a fall.

    "One airline changed its policy after it emerged that a BME doctor’s offer to assist in a medical situation was turned down by the crew. " - The result of that case was to stop asking people who offer help for their credentials. I.e, ANYONE who claims to be a doctor offering help, would be allowed to help. I'm not sure that's an improvement.

    2. Vox and the Guardian are hardly objective news outlets, many class them far-left, identitarian, RACE-BAITING, etc.

    3. And then to group representation in any field/sector/position: As Thomas Sowell said, and I paraphrase, there is no evidence that any specific field is better for being exactly representative of the population at large. E.g, Just because M:F is 50:50 in the population, does not mean that it is better for the ratio to be 50:50 in all subgroups. Do you want 50:50 in coal miners? Oil rig workers? Bricklayers? Nurses? Doctors? Frontline armed forces personnel? Prisoners? So you now want proportional representation at every level or just at the top? Would you now want to preferably train doctors by gender then to make it 50:50, i.e. AFFIRMATIVE ACTION?
    Are you happy to pay for such a state bureaucracy to regulate this?

    And then we come to the disparities you mentioned, clearly the reasons are multi-variant, but an easy scapegoat is race isn't it? How about merit, communication skills, language, culture, work practices, beliefs, behaviour, personality traits, even intelligence? And it has been illegal to discriminate purely by race/gender/etc for decades. It's easy to scream racism, its harder to prove in court, as shown by the CSA fiasco. And I'm one of the few who still believes in 'innocent until proven guilty'.

    Finally, and I say this as someone who is also BME, but values truth/evidence/merit above all else, there is strong evidence that a 'preference for the familiar' is evolutionary/biological/tribal in origin, read Richard Dawkins. Now that might no longer be entirely 'preferable', but it might go some way to explaining it for you.

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