Dilemma: Racist patient
During a consultation with a patient who is disgruntled about perceived shortcomings of your practice, the patient states, angrily, ‘These problems always seem to come up when I see a Paki doctor. I don’t mind coming here and I’m not a racist but I refuse to see any more Paki doctors.’
Two of the GPs and the current registrar are of Asian origin. How should you handle the patient who expresses racist views which threaten to impact on his medical care?
Have a clear ‘zero tolerance’ equality and diversity policy
This is a question about values. To take no action is not an option in my view. Some doctors would argue that the doctor-patient relationship is of paramount importance and would feel this could be jeopardised if one took this up with the patient. But one must also support ones colleagues, even if they were not present to hear these remarks. Silence might be deemed to be supportive or colluding in some way with the patient.
In my experience it helps to have a clear, unambiguous ‘zero tolerance’ policy for equality and diversity, to be used for exactly such an eventuality. It then gives something to discuss and saves you, as the doctor, having to express an opinion. After all, it is never easy challenging another person’s beliefs, however erroneous. It depersonalises things so one can say it is against our rules. Such a policy could even be referred to in a patient-practice agreement that new patients sign. Indeed having such an equality and diversity statement in clear view at reception may have sent the signal that such comments are not acceptable.
The real question is what to do now. The law in this area is vague and untested. It may be you could assert a breakdown in relationship and ask the patient to find another GP, or verbally challenge the patient. Either way things ought to be put in writing, perhaps after discussing at a practice meeting. One would also need to explore what exactly the doctors allegedly did wrong, as the patient may very reasonably prefer not to see those doctors again. However, it would need to be made clear that they may have to see these doctors again in the future in the case where they are the only doctors available .
If I were one of the doctors referred to, or indeed another ethnic minority doctor in the practice, I’d be concerned that the patient carries prejudice making the relationship more likely to be strained and hence more likely for the patient to put in an unfair complaint against me in the future. After all, south Asian doctors are highly over represented in GMC complaints.
Dr Rafik Taibjee is chair of the BMA Equality and Diversity Committee and a GP principal in Merton, south London
Ensure that affected employees do not have to see that patient again
This is a tricky situation which raises several legal issues. The registrar, and the GPs if they are salaried, are employees of the practice and may allege that they are being subjected to racial abuse or harassment by the patient. As their employer, the practice could be liable for such harassment because both the Equality Act 2010 and the Protection from Harassment Act 1997 give employees protection from suffering third party harassment.
The Equality Act provides some limited ability for the practice to defend itself against a claim where it can, for instance, show that it has taken reasonable steps to prevent instances of harassment from occurring. However, any offence of harassment under the Protection from Harassment Act would be one of strict liability (i.e. no defence).
Practically, it’s unlikely the employees would take immediate legal action against the practice. More likely, they would raise a grievance and the practice’s response to that grievance would be critical. Steps might need to include ensuring that affected employees do not have to see that patient and warning the patient that he is at risk of removal from the practice’s list is his behaviour is repeated.
For guidance on the key points about removing patients from your practice’s list and the process that needs to be followed, please see ‘A quick guide to de-registering patients’.
Andrea James is head of healthcare regulatory at George Davies Solicitors LLP, a former in-house solicitor to the General Medical Council and specialises in advising doctors.