Hi, I’m Hardeep and as a Cambridge medical student, I’m lucky enough to say I haven’t experienced any racism or discrimination in medicine.
Well, I mean I’ve had a medical colleague ask me “why I’m so hairy?” and another assume I couldn’t attend an event because I was having an arranged marriage. But they were clearly just joking.
Also, I did have a white, male colleague smugly ask me “why I feel so victimised?” and “how bad can it be given you’re in Cambridge?”. This colleague is now a doctor, so he must have a valid point on some level.
I’ve had another white, male colleague make a joke at my expense upon hearing the large proportion of Pakistani doctors that are reported to the GMC. But he knows I’m not Pakistani, and he’s also a doctor now so probably didn’t mean it that way?
I’ve never had anyone directly say to me that they don’t like me because of the colour of my skin, therefore I’ve never experienced discrimination. Besides, they were all clearly just joking, or didn’t know any better. It’s my fault for being so sensitive, and if those comments perturb me then I’ll never make it as a doctor in the NHS. I need to be more resilient.
The reality
Unfortunately, this is the inner dialogue of many BAME medical students and goes some way to explain the astounding statistics behind NHS discrimination and racism. For example, a black mother is over five times more likely to die in childbirth than a white mother [1] and BAME staff are more than twice as likely to experience discrimination compared to white staff (probably more, due to under-reporting) [2].
As a medical student or Junior Doctor, you have the duty to challenge and address this: not only will your patients benefit, but your colleagues will as well. This is a systemic, societal issue with multiple facets so as a disclaimer, I’m by no means saying I have all the answers. However, I think it’s worth providing information and simple steps to facilitate allyship.
How to be an ally
When looking at my personal experience, the common feature behind all of them is assumption. This is also the case in wider NHS discrimination: assuming a black patient is seeking unnecessary pain relief, assuming a BAME patient is less scientifically literate, and so on. So how do you challenge assumptions?
Action point 1: Have a conversation with a BAME student
From a broad perspective, conversations from different perspectives will widen your horizons and make you think. It provides an easy, beneficial starting point to the entire idea of being a BAME ally and will go some way to reducing your future contribution to racism and discrimination (whether conscious or unconscious). That leads me onto the second action point:
Action point 2: Have a conversation with yourself
Normally “acknowledgement” comes before “discussion” but I think once you hear from your BAME friends about their experiences, you can ask yourself the key questions: do I have any biases? Have I contributed to discrimination? Have I supported my BAME friends or asked about their experiences?
Please note, this is usually the point where people throw up objections such as “I know I’m not racist” or “it isn’t my fault, I’ve grown up in a white area”. The first thing to remember is that no-one is blaming you or saying that you’re consciously contributing to negative BAME experiences in healthcare (and if it is conscious then that’s a separate issue, and you should arrange to have a coffee discussion with me).
If you can truly, honestly acknowledge your own thoughts, feelings and experiences then you can begin to help BAME colleagues through the next action point.
Action point 3: Identify when discrimination/ racism happens and help!
Once your healthcare brain is calibrated to “discrimination mode” you will begin to see its insidious nature in healthcare. In particular, look at how healthcare professionals treat BAME patients compared to white patients. If you see something unprofessional or inappropriate happening, a non-confrontational discussion can be very productive, whilst also limiting the worry about getting in trouble for “calling out” a potential superior. I appreciate this can be difficult, and is not always possible to do there and then (SJT scenario gold right here) but you have to remember something:
As a person of colour, by taking issue with racism and discrimination you make yourself a further target in an already vulnerable position. When you see your friends contributing to this, and not defending you or trying to understand, you feel a hopeless panic as you realise if those closest to you are willing to let this happen, you’re truly alone in the struggle.
This mental calibration is not just for clinical experiences, but can also be seen on the course, which leads to the next action point:
Action point 4: Discuss with your medical school
Medical school curricula are still being dragged into the 21st century, and BAME representation is very much a part of this. The way we are taught is very much categorising into the “normal” physiology, anatomy and treatment and the “other”. At Cambridge, the faculty seem to have listened and responded to student views on de-colonising the curriculum. Certain specialties, particularly Psychiatry and Dermatology, have taken steps to address the shortcomings in the curriculum. This is progress!
However, just addressing medical school is not enough, because the NHS is more than just doctors. With that being said:
Action point 5: Discuss and challenge at home
As a medical student or junior doctor, I’m sure you’re asked plenty of questions at home, normally centralised around this week’s new lumps, bumps and cough. Chances are, your family listen to you and respect your viewpoint, so use that pedestal to help your BAME friends and colleagues!
This is especially important for the older generations, who are quite often the “offenders” in healthcare. Given the massive uptake in telehealth in the elderly population, I don’t believe that we can still maintain a defence based on claims such as “they’re stuck in their ways” or “it’s a generational thing”. I’m not expecting U-turns, but at the very least conversations and addressing potentially troubling viewpoints can be a start.
Final thoughts
I would like to sincerely thank you if you’ve made it this far, because this can be a difficult issue to address and is by no means an easy fix. I’d also like to make an important point: whilst a good chunk of medical professionals are very supportive and understanding, and a small proportion are discriminatory and racist, most people exist in the middle. Importantly, it’s not enough to just know “racism is wrong” if you’re not going to address it, or actively take steps to challenge it.
We’ve made progress in the last few years addressing racism, sexism, homophobia, transphobia and other wider societal issues that affect the NHS. However, there is still so, so much to be done and the conflict appears to be widening due to inflammatory political and religious stances and the unhelpful behaviour of major leaders.
As medical students and junior doctors, the pandemic has brought an even greater level of respect and admiration from the general public. But remember: the same voices that cheered for the NHS may also be the voices of abuse and discrimination.
We can do better. And we will.
[1] ‘MBRRACE-UK Maternal Report 2019 – WEB VERSION.Pdf’. Accessed 12 October 2020. https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202019%20-%20WEB%20VERSION.pdf.
[2] ‘Wres-Evaluation-Report-January-2019.Pdf’. Accessed 12 October 2020. https://www.england.nhs.uk/wp-content/uploads/2019/09/wres-evaluation-report-january-2019.pdf.
I’m a Cambridge medical student with an interest in medical communication and education. In particular, I enjoy creating content for students, patients and professionals that addresses lifestyle education and general wellness; nutrition, exercise, sleep, stress and mental health. I hope to contribute to a pro-active healthcare model that embraces personalized healthcare and telemedicine.