Intended for healthcare professionals

Rapid response to:

Feature Ethnic Discrimination

Minority report: how the UK’s treatment of foreign and ethnic minority doctors needs to change

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2838 (Published 22 April 2014) Cite this as: BMJ 2014;348:g2838

Rapid Response:

Re: Minority report: how the UK’s treatment of foreign and ethnic minority doctors needs to change

Few have dared to raise the possibility of differences in patient-centred consulting skills in ethnic minorities or foreign doctors throughout this row on discrimination in general practice. Researchers seem to have taken into account race, ethnicity, language, international graduation and clinical skills but have they considered patient-centred consultation skills in foreign or ethnic minority doctors?

Patient-centred care is a cornerstone of UK general practice. GP trainees passing the RCGP CSA exams have to demonstrate patient-centred consultation skills which include open communication, mutual decision making, understanding, trust and respect. It is the ability of a doctor to manage patients holistically. It is simply not enough to have the clinical ability to able to be able to treat a disease, UK GPs need to incorporate the patients’ illness experience. As an ethnic minority doctor myself who has recently sat the CSA exam, I believe that the ability of a doctor to consult in this manner is influenced by medical training, country of origin, culture and experiences. Doctors trained abroad in countries where a paternalistic model of medicine is the norm may therefore struggle with patient-centredness. Similarly, culture and experience can influence doctor-patient interactions towards more doctor-centred consultation. With this in mind, foreign doctors may struggle with assessment such as the CSA which takes patient-centred consultation skills into account.

Remove race, ethnicity and country of graduation as the only cause of these differences. Instead, measure a doctors’ ability to consult in a patient-centred manner and I wonder if we will find differences between foreign or ethnic minority doctors? There are many patient-centred care measures that have been validated and widely used in general practice.[1,2] Why don’t we utilise these more widely in research to better understand the cause of this issue, and whether patient-centred care consultation skills in foreign doctors or ethnic minorities is contributing to failure of exams. If this is indeed the case, it will help us to understand the problem a bit more and focus our training, support and changes accordingly.

1 Hudon C, Fortin M, Haggerty JL, et al. Measuring patients’ perceptions of patient-centered care: a systematic review of tools for family medicine. Ann Fam Med;9:155–64. doi:10.1370/afm.1226

2 Mercer SW, Maxwell M, Heaney D, et al. The consultation and relational empathy (CARE) measure: development and preliminary validation and reliability of an empathy-based consultation process measure. Fam Pract 2004;21:699–705. doi:10.1093/fampra/cmh621

Competing interests: No competing interests

24 April 2014
Hajira Dambha
Academic Clinical Fellow in Primary Care
University of Cambridge
Department of Public Health and Primary Care, University Forvie Site, Robinson Way, Cambridge, CB2 2SR