Discrimination in discretionary points award scheme: Premise is flawedBMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7400.1214-d (Published 29 May 2003) Cite this as: BMJ 2003;326:1214
All rapid responses
When Jay Ilangaratne says, “It is a well known fact that people who
discriminate against others (either on the basis of race or sex) do not go
around advertising the same,”  then I think such observations, valid
though they are, ought to be placed into a more neutral context. A context
that is cognisant of social realities.
By and large today we live in a meritocracy, which means that people
move up and down in society largely because of their worth, value or merit
as people, as human beings, rather than by virtue of their colour,
appearance, religion or gender. Patronage is very largely dead and buried;
thank goodness for that. Most of us applaud this shift. As a result, the
original and ancient divisions and prejudices that existed between
peoples, or social groups, such as those based upon race, gender, etc, and
that often formed such rigid barriers to progression and dialogue, have
largely been dissolved and eroded, have become muted or rendered invisible
in the last fifty years or so. Though still present to a diminishing
extent, they are increasingly and manifestly outmoded means of social
process, social control and social discernment.
Regrettably, they do persist to some degree here and there in
pockets, because we all need to make value judgements of other persons in
some way so as to sift wheat from chaff and choose who we like and
socialise with and who we don't; who we regard as virtuous and worthy and
who we don't. These are ever-present and timeless human needs.
Unfortunately, appearance - race and gender - was very widely used as a
crude and prejudicial means of social discernment.
When we assess human behaviour now, and especially in times past, we
must be cognisant of the rather strict social stratification into layers
that pertained in times past and by which people judged each other
[perhaps rather too harshly?] as belonging, somewhat immovably, to one
class or another simply by virtue of their birth, economic status and
social class - such as by race, gender, geographical location, etc. As
with the caste system in India, this was in truth merely a rather crude
mechanism of social discernment and separation that was quite typical of
many countries pre-1900.
People today still have social roles and social identities and in
their dynamic interactions still need to make value judgements about each
other, but the system today is much looser, less formal, less prejudicial
and less harshly applied than it was in the past. People always have and
always will need to evaluate each other in some way and make decisions
based thereon; it is just that today such judgements tend to be made less
prejudicially or harshly and more neutrally. The basic concepts and
methods of social roles and social identities, conformity and social
deviance, all still apply in societies today as they ever did in times
past. It is just that the 'rules' today seem looser, less prejudicial and
fairer than they appeared to be in times past. Whether they will ever be
absolutely fair is open to question.
In specific relation to racism, then one hopes this will in time
gradually subside of its own accord as people freely mix with each other
and become genuinely more tolerant and compassionate of each other as
human beings first. Increasingly in such a situation, skin colour and
gender tend to take second place to the actual skills and qualities a
person possesses, and upon which their true worth should more correctly be
judged. One also hopes that those guilty of all forms of racism will
dwindle down to a tiny minority, as more liberal attitudes pervade all
cultures. Would that not be a quite positive gift of so-called
 Jay Ilangaratne, Discretionay Points and Racism, BMJ letter, 2
 Letters, Globalisation and health, 5 January 2002, various
Competing interests: No competing interests
With the greatest respect to Everington and partners, I do find it
tiresome for them to simply concentrate on one aspect of medical
Racism in the National Health Service exists, we know it exists. What
is the point of labouring on and doing numerous studies on the same point.
Being hailed as the saviour of those who suffer racism and providing some
ground breaking stats does not really help the average doctor.
Quite simply though - I am a doctor. I work in the National Health
Service and while these guys who spend their lives counting data produce
great studies in the BMJ, I do not find that it assists me when fighting
discrimination in the workplace. When push comes to shove, many doctors
are left to their own devices.
Scores of patients suffer a thousand times more than asian doctors
do. Inequality in medicine exists not only for doctors but certainly for
many patients. The problem with studies of this sort and stamping the
floor about discretionary points is this - our disadvantages as doctors is
nothing in comparison to the amount some patients are forced to suffer.
As doctors especially asians - we sit around the parties, pout about
how discriminatory the system has been to us, spend thousands taking
Trusts, the BMA etc to court but has anyone thought to be slightly less
selfish and consider the plight of others.
Indeed, discrimination exists within individuals and one should
accept that people do not change unless they have to. The key is to
circumvent them and get on with our own lives.
The energy some doctors spend in bashing the system up about racism
is amazing. If they spent a fraction of that time assisting the elderly
lady whose relatives do not understand the treatment given to her, the
patient who remains in A and E for hours, the disabled person who faces
the nursing staff crisis hence is not fed etc, then I am sure their narrow
minded world would open up.
In my own experience of racism campaigners in the asian population,
none of them have offered to assist patients or their fellow junior
doctors out of the kindness of their heart. Indeed, they have only had
tunnel vision where their suffering (via racism) is the most important of
them all. It as if they stand in front of the mirror and say " Mirror
Mirror on the wall, who is the person who has suffered most of all". A
number of prominent asian seniors who are supposed campaigners for doctors
rights have not lifted a finger to assist juniors who find themselves
discriminated or victimised. I have discovered that the self importance of
these doctors and indeed arrogance is shocking. Indeed, I am critical of
the asian population of doctors because I have personally found them to be
extremely unhelpful in many cases of injustice.
In the grand scale of things, discretionary points is a small point
in comparison to the reality and injustices suffered by many patients and
doctors in general.
Dr Rita Pal
The Truth Behind the White Coat
Competing interests: No competing interests
It is a well known fact that people who dicriminate against others
(either on the basis of race or sex)do not go around adverstising the
same.There are ample legal authorities to that effect.So in any
discriminination case,proving causation is a difficult hurdle to
cross.However,probably apprciating the difficutties in this regard, the
Race Relations Act 1976 had been drafted so that tribunals and courts can
draw inferences from the primary facts it had found.
Therefore, an overly onerous test should not be applied to the
findings in Esmail's paper.Especially, introduction of exlusion criteria
such as "emotional intelligence"(as suggested by Dr Lack)before inferring
race dicrimination, would be less than objective and unjust. Regrettably,
suggestion of such terms("emotional intelligence") indicate a rather
sophisticated attempt to reintroduce the terms "sensitivity or
hypersensitiveity" which have been widely used by those who wish to rebut
claims of racial dicrimination. Fortunately,however, the use of such
terminology in relation to dicrimination law had been outrightly rejected
by the Court of Appeal.
When racism is no longer a secret in our society, and pervades the
NHS, it is surprising that one could logically argue that it would not
have any effect on the discretionary points award scheme.Dismissal of such
real possibilities would only add further worries to the fairness of the
system.Perhaps, Dr Lack is not aware that at least one NHS Trust had been
found guilty of race discrimination in relation to points awards.
On a slightly positive note, the burden of proof in relation to race
claims will come into line with EU legislation shortly. As a result, the
onus of proof will be on the defendants rather than on the claimant upon
there being a prima facie case of racial discrimination.So absolute
transparency of the defendant's systems and procedures would be crucial if
one intends to defend claims, successfully. Only, time will tell whether
this would bring improved justice to victims of discrimination.
As the world realises growing problems due to racism, some look
towards novel ways of combating racism and improving race relations. The
following website is one that fall into that category: www.rent-a-
Competing interests: No competing interests