I write this article, in the light of events personally, nationally and now internationally following the killing of George Floyd.
The initial trigger for this article was late 2019 when one of my patients made a parting racist comment to my medical students at the end of the consultation.
As the GP tutor, I really didn’t know how to respond; whether to apologise for another person’s error of judgment or how to placate the visibly shaken student.
There is no GMC equivalent to report patients to, so the only thing I could think of at the time was to comfort them by sharing my experiences of handling racism, not only from patients (as sadly this is now commonplace) but also from colleagues.
My reply was: ‘It’s sad, but you will get more of this.’ I advised that the best way to deal with it is to let your good work and excellent patient care do the talking for you.
I subsequently asked the patient to reflect on her comments and she sent her profuse apologies.
A report from the BMA in 2019 found that black, Asian and minority ethnic (BAME) students’ confidence and learning is being damaged by racism.
Meanwhile, last year the GMC published a report suggesting that a lack of support, isolation and poor feedback could be behind high rates of GMC referrals for doctors from BAME backgrounds. The GMC commissioned the report because BAME doctors are more than twice as likely to be referred by an employer to fitness to practise procedures as white colleagues.
Episodes of discrimination
My first experience of racism as a doctor has stayed with me. It was a question from my consultant in 2002 when I started training. He asked: ‘Where are you from?’ I replied I was British (since I was born in London). He replied: ‘No, I mean where are you really from?’ Then he said I looked like a ‘penguin’ in my ward coat.
This was the first of many episodes of being made to feel different in a negative way
I came to realise that my innumerable episodes of discrimination are not only due to my skin colour but also to my African name and accent. These three things are the ways I'm judged whether it be an application, at interviews or on the job itself.
At each new post, I’m watched very carefully and colleagues are reticent to relate to me. I worked out that it took six months on average (both as a hospital trainee and also in general practice) before I was finally accepted by colleagues.
Patients also ask a lot of questions to make sure I am qualified to be treating them. One patient, a solicitor, admitted he had looked me up online, long before social media was commonplace. The fact I’d had articles published online gave him the confidence he needed, but I wasn’t quite sure how to receive this bit of information – was it an insult or compliment?
I have also received a number of what my appraiser described as ‘soft complaints’ i.e. those with little substance to them - such as being reported for not prescribing ibuprofen, or receiving a page-long complaint from a patient in 2007 because I wouldn't prescribe antibiotics for a viral sore throat.
As a long-term locum I have come across a number of patients who vehemently complain about the lack of care provided by their white GPs, but only verbally to the ‘messenger’ duty locum. On the other hand, if a BAME doctor were to commit the same or a lesser offence, patients are quick to lodge official complaints verbally, in writing or even going as far as reporting to the GMC.
It’s not just patients
The sad truth, however, is this is not confined to patients. Discrimination is also meted out by colleagues – both subtly and overtly – and, for me personally, this is more disheartening.
Some of my colleagues have been downright rude. I’ve lost count of the times I’ve been ignored at educational meetings where I inevitably find myself as one of the few, if not the only, black doctor present.
When I try to interact or talk to some colleagues, they either walk away or avoid eye contact and hope I walk away. I have had to work extra hard to be included and listened to. I remember the look of surprise from a meeting chair when I put up my hand to also ask a question in a meeting and noted no one else received such a surprised stare.
Once a GP partner cancelled my family planning clinics without even telling me in person. I found out via the email sent to alert everyone that I was no longer doing the clinics. I later found out that the reason was simply because one of my patients’ husbands was rude to the GP partner while they were waiting for me.
The other partners didn’t stick up for me or even ask me what happened, so I decided to leave the service as I obviously didn’t matter to them.
Another case happened a few years ago when I learnt that I had been reported to the responsible officer by my new appraiser before we had even met for the first time.
Why? Well, one of my recurring PDP goals was that I’d keep abreast and informed of as many specialities as possible to help me in practice as a GP. My other appraisers had applauded this, but this appraiser felt it was too generic and needed specificity and wondered why other appraisers had passed me.
During the actual appraisal, he realised that he hadn’t checked properly, nor seen all the data entries about the courses and CPD that I had done and reflected on. He went on to admit ‘you have learnt a lot', apologised profusely and we now have a cordial professional relationship.
Pondering afterwards, I couldn’t help but think that if I was a white doctor, he would have waited for me to attend the appraisal first to explain the situation, rather than reporting me to the responsible officer before I even arrived.
The crux of the matter
Some people may suggest that I am being over sensitive and that these experiences are ‘imagined’ racism. However the bottom line is that repeated unfair treatments meted out to BAME doctors by both patients and colleagues is hugely demoralising and is the reason why many burn out or worse.
Look at the coverage of the COVID-19 pandemic, for example. From watching TV one could be forgiven from thinking that only white doctors and nurses were on the frontline, until the BAME staff started dying.
My hope is for colleagues to reflect and recognise their own bias towards BAME doctors and then try to overcome this. Perhaps by getting to know them?
As medics, we all know what goes into our training to be a doctor - the long years, the expense, the stresses and pressure of high-intensity studying.
Imagine leaving your country of origin and everything you know, to go and practise elsewhere – and then being on the frontline and even risking death as we have seen from the COVID-19 pandemic.
Many doctors only emigrated to the UK in the first place, due to the economic or political situation in their countries of origin, that were often created or contributed to by the legacy of colonialism in the first place.
The reality is that it is hard to settle and flourish here. You feel unwanted and devalued. There are language and cultural barriers, plus lots of red tape to navigate to gain accreditation in a system that did not train you, including the inevitable expense of funding licensing exams in a currency you don’t even earn.
On qualifying, there is then the huge workload and never-ending CPD, while trying to maintain a work-life balance and, in lots of cases, doctors and other staff are also sending money home to desperate relations.
Healthcare professionals should aim to better understand their ‘different’ colleagues. Comprehension of their experience, coupled with fairness and respect for them as fellow workers, will go a long way to ease the pain of discrimination and racism.
All NHS staff should be valued and appreciated for our role. We are not asking for favours, only the right to be treated justly. The fairer the system, the higher the staff retention leading to a reduced workload and the happier all will be.
That surely is worth trying to achieve.
- Dr Nonye Agomo is a GP locum, medical writer, author and GP tutor in London and winner of the UCL Excellent GP Tutor 2019