Reporting racism on the wards
Racist remarks from patients and colleagues are not uncommon in the NHS, but there is a lack of support and guidance for students on how to report incidents
From remarks about their origin to outright verbal abuse, many black and other minority ethnic (BME) medical students have personal experience of racism on the wards. Some of the abuse comes from patients, but some also comes from colleagues, including those in senior positions.
Although some BME students report becoming reluctantly “acclimatised to” or excusing these interactions, medical diversity experts say that these incidents need to be better handled to create a culture of zero tolerance within the workplace. A third (34%) of UK medical students (13 563 individuals) are BME, according to the General Medical Council.
Unpublished research findings from University College London show that at least a third of 140 senior medical students at the university who replied to a survey had witnessed some form of racism from staff or other students.
A student of African descent told Student BMJ that a lack of support from her consultant left her in tears after she was “degraded” by a racist remark from a patient during a clinical placement.
The student and five of her colleagues had gone to examine a patient along with their supervising consultant on a hospital ward in Scotland. “Halfway through, the consultant asked us some clinical questions and we all took part. A patient pointed a finger at me and said the words ‘she likes chocolate, surely she must like chocolate this one,’ followed by a laugh,” the student said.
The incident went largely unacknowledged at the time, apart from a few surprised looks and a nervous glance and smile from the consultant, leaving the student feeling “uncomfortable and humiliated.” There was no debrief afterwards. “I felt let down that the senior doctor didn’t address it. I expected him to have acknowledged it as an inappropriate comment, but nothing was said to me or the patient, which makes it look like these types of comments are okay, which they’re not.”
The student is one of several to contact Student BMJ unprompted in recent months, highlighting the issue. In addition, posts on social media forums have revealed many other examples, including one British BME medical student who reported having three experiences of racism in the same week, including being subjected to a “rant about foreign doctors” and being told, “You speak very good English for a foreigner,” by patients.
Some patients have also refused to be seen by a BME student or doctor, as reported by a London based fourth year student on a critical care placement:
“As soon as the patient saw that I was black, they said, ‘Sorry but I’m not being treated by a black doctor. No way. Isn’t there an English doctor around?’,” he says.
A relative managed to calm down the patient, who then “begrudgingly” spoke to him. The student says he has tried to “make excuses for it due to the patient’s distress,” but adds that these comments are “always going to hurt.”
The BMA medical students committee deputy co-chair for welfare, Gurdas Singh, wears a turban and has experienced quite a few racist comments from patients as a result of “looking different.”
Singh says that students should report their concerns to their clinical supervisor at their medical school, who will be able to advise further and help escalate the issue if appropriate.
The BMA advises that you should keep a diary of any incidents where you have been bullied or harassed in the workplace (including what was said, dates, times, who was present, and how you felt), as well as making your employer aware of the situation.
“Unfortunately, some students still experience inappropriate behaviour from patients and staff and have the impression that their complaints won’t be taken seriously. No one should be left feeling they just have to put up with such treatment,” adds Singh.
The GMC’s education standards set out that organisations must create safe and supportive learning environments where students are not subjected to behaviour that diminishes their professional confidence, performance, or self esteem.
GMC director of education and standards Colin Melville says, “We urge medical schools and employers to address such incidents promptly and sensitively.
“We expect medical students to treat all patients with respect and dignity. It’s only right that they receive the same courtesy in return.”
Researching racism in medicine
The GMC’s most recent research into racism found that white UK medical graduates are more likely to pass specialty exams than their BME counterparts.
University College London Medical School has a strong history of conducting research into inequalities in education, in particular those relating to ethnicity and gender.
Katherine Woolf, deputy lead for research at the medical school, and colleagues published a research paper in 2008 in the BMJ showing that clinical teachers and medical students can hold negative stereotypes about Asian and other BME medical students. The findings “raised the possibility” that these negative stereotypes could impact BME medical students’ learning and achievement.
“More recently, we have interviewed trainee doctors and trainers from around the country and found that BME trainees—including those who went to medical school in the UK, as well as those who qualified abroad—can find it harder to get the support from seniors that they need to achieve their potential,” Woolf says.
Woolf’s colleague, Jayne Kavanagh, has also led a survey of senior medical students at University College London to gain a better idea of the prevalence of racism. “Initial results suggest that around 5-10% of students who responded had witnessed what they perceived to be ‘blatant,’ aka direct racism, from other students or from staff, and a third to a half had witnessed what they perceived to be ‘less obvious’ racism, in the form of jokes and banter,” reports Woolf.
“It is very important to note that this does not mean 5-10% of staff are racist—it could be that one staff member said or did something and it was witnessed by a large number of students. Any experience of racism, blatant or subtle, is of course concerning, though.”
Responding to racism
Dinesh Bhugra, professor of psychiatry and diversity at King’s College London says racist incidents in the NHS are “not uncommon.”
He recalls an incident in which a patient was “incredibly racist” towards him, using a derogatory term, and suggesting that he should be doing her laundry.
“I said, ‘If you are going to carry on like that, I am not going to treat you,’” Bhugra reports.
“As a consultant I can stand up to that behaviour, but for a trainee it can be quite difficult.”
He has also experienced racism from fellow doctors. “When I was dean of the Royal College [of Psychiatrists] someone came up to me and said, ‘What do we have to do to get you to speak proper English?’” Bhugra recalls.
He says senior staff need to support juniors by giving them a safe space to talk about such incidents, need to acknowledge derogatory comments when they happen, and need to talk to patients directly about unacceptable behaviour or language.
In January 2017, Bhugra chaired an independent inquiry into issues of racial equality at Cardiff University Medical School, which concluded that a play in which medical students had used blackface make up had led to a feeling of segregation among ethnic groups at the university.
It called for the university to provide students with guidelines on complaints about racist incidents and other forms of discrimination, to provide mentoring, and to address unconscious bias and stereotyping within the school curriculum.
Bhugra says medical schools need to improve the support they give students before they start their clinical placements by giving them clear guidance on where to turn for help and support when a racist incident occurs.
“Students need to feel reassured that making a complaint about racism will not affect their career progression. Ideally, there should be a ‘go to’ named person associated with their medical school who can provide pastoral and practical support,” Bhugra says.
<box title> What to do if an incident occurs
Challenging a patient or colleague over a racist remark is not easy, and medical students should only do what they are comfortable with.
This is the advice of Professor Nisha Dogra, who is the lead for integrating diversity into the medical curriculum at Leicester University and a child and adolescent psychiatrist.
She says there are different approaches to take, depending on who is inflicting the abuse and whether the comment is obvious personal racism or a more general comment—for example, about foreign doctors.
Dogra suggests that when a patient asks the question, “But where are you really from?” you could say, “I wonder what makes you ask that?” She says, “That tends to start a conversation rather than an argument.”
Dogra advises that in the case of more blatant racist comments, students can say, “I am going to have to stop this [whatever they are doing, as long as it is clinically safe to do so] and speak to a senior colleague,” and then report the incident.
She admits there is still a level of discomfort among senior staff about how to handle these situations.
“We are teaching medical students better how to deal with some of these issues, but not necessarily teaching our workforce to keep up with [these advances],” she says.
She advises students to avoid directly challenging a senior colleague who is abusive because this is unlikely to be productive, but to report it to the relevant staff at the medical school.
The University of Leicester medical school has recently started to record all incidents where inappropriate comments, including racist ones, are made. This is at the end of students’ rotations, although students are free to contact medical school staff at any time. The intention is for the university and the Leicester NHS trust to work together to ensure that the clinical environment for students is safe and non-discriminatory.
University College London has also launched an online resource that provides guidance for students on what to do if they or a colleague has been discriminated against because of their race, sex, or sexual orientation.
Competing interests: None declared.
Provenance and peer review: Commissioned; not externally peer reviewed.
- General Medical Council. Number of students in UK medical schools and their demographic groups in 2016/17. 2017. www.gmc-uk.org/201617_Medical_School_Annual_Return___overall_student_numbers_and_demographics.xlsx_71843956.xlsx.
- British Medical Association. How to address bullying and harassment at work. 2017. www.bma.org.uk/advice/work-life-support/your-wellbeing/bullying-and-harassment.
- General Medical Council. Promoting excellence: standards for medical education and training, Theme 3: Supporting learners. 2017. www.gmc-uk.org/education/27392.asp.
- General Medical Council. Independent research for the GMC shows ethnicity still a factor in future doctors’ prospects. 2016. www.gmc-uk.org/news/27480.asp.
- Woolf K, Cave J, Greenhalgh T, et al. Ethnic stereotypes and the underachievement of UK medical students from ethnic minorities: qualitative study. BMJ 2008;337:a1220.
- Woolf K, Rich A, Viney R, et al. Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study. BMJ Open 2016;6:e013429.
- Cardiff University. Independent review panel into issues of racial equality in the school of medicine, Cardiff University. 2017. www.cardiff.ac.uk/__data/assets/pdf_file/0011/551837/Prof-Dinesh-Bhugra-report-Final.pdf.
- University College London Medical School. Raising Concerns. 2017. www.ucl.ac.uk/medical-school/quality/raising-student-concerns.