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Same difference?

GP-to-be Dr Syed Arfeen argues that to discriminate appropriately is not a bad thing for a GP to do

When I was at medical school I recall walking down a corridor in campus and seeing the posters for the upcoming student union elections of the aspiring hopefuls and being taken by one poster in particular. It was for the position of equalities officer and his slogan ran: 'Because not everyone is the same'.

This had bemused me for a long time since, wondering if this was a catastrophic mistake - as surely an equalities officer should be suggesting that we are in fact all the same - or if there was a more esoteric implication that we aren't and that is why there is need for an equalities officer to champion the cause to ensure different people are treated fairly.

I recall this moment every time I read the RCGP curriculum statement on equality and diversity. Its particular qualification of the terms in practice are only to ‘act in ways that recognise that people are different and do not discriminate against people because of those differences.'

So what does this really mean? It's almost as confusing as the student union poster. Is it that I recognise that patient X and patient Y are different but I don't treat patient Y any worse than patient X because of that difference. Sounds good so far. But what if the difference between them is for example patient Y not speaking English and requiring double the time than patient X? Or, lets say patient Y has all the factors for a metabolic syndrome requiring more intensive investigation and treatment than patient X who is without those. As far as I understand it, the implication is that I give patient Y more time and effort in an attempt to bring them up to a comparable level to patient X. To give patient Y more time and effort is to discriminate - albeit more as a case of for them rather than against them - but is that then an implicit discrimination against patient X merely because of their good English language ability and good health?

After all, in a parallel with tax system where the better off pay more to effectively subsidise the worse off in an attempt to bring some level of parity, the better off decry being dealt with unfairly merely because of their position that is a result of fate or their own hard work, neither of which they feel should be reason for taking a greater and unequal share of the burden.

Or perhaps the RCGP statement implied only that once the difference between patient X and Y have been recognised, that to not discriminate would mean merely to give patient Y the same amount of time and effort as patient X and leave it at that. This way nobody is discriminated for or against. Yet somehow, that appears unsatisfactory too.

The resolution of this lies in the appreciation of the difference between treating people equally and treating people the same as they are not equivalent. How to compare a square and a circle? They are both shapes that can be drawn of the same perimeters and colour ink, but ultimately they have their own inherent properties that dictate their nature and function and which is the basis for their difference. Likewise with different people.

Whilst we are all humans, we have out individual anatomical, physiological, mental and social properties that are the basis of our differences and to which we should be treated accordingly to. This will not be the same. For example, comparing a male and female patient. In respect of what they have in common they deserve the same treatment and yet in respect of their differences they should be treated appropriately to their case which will not involve being treated the same as the other but will mean they are being treated equally.

Difference and discriminate appear to have become dirty words used only with negative connotations which is unfortunate as the differences between us as people an patients should be celebrated and not treated as a problem in preventing us being able to uniformly treat them as a conveyor belt of biological material. Difference is a reality amongst us all. Our fingerprints, annoying habits, personal frames of reference and so forth, and discrimination is only to recognise and respect those differences.

Hence, I would reword the RCGP curriculum statement to more along the lines of, 'act in ways that recognise people are different and discriminate against them appropriately according to those differences where possible to deliver optimal care.'

Why? As my student colleague said back then - because not everyone is the same.

Dr Syed Arfeen is a GP registrar at the Emperor's Gate Surgery in Kensington, London.

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