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Views And Reviews

The NHS owes doctors who trained abroad an apology for racism

BMJ 2018; 361 doi: (Published 31 May 2018) Cite this as: BMJ 2018;361:k2360

Re: The NHS owes doctors who trained abroad an apology for racism

The article is very reminiscent of many of the experiences that my (late) father would recollect from his time as a hospital SHO/registrar in the '70s and then as an inner city GP in the '80s. It was common behaviour to just soldier on (always smiling) in the face of overt racism from staff and patients. This included the extra hurdle that the author describes of having to 'prove' himself as a non-white GP to the locals whilst quietly cleaning up casual acts of vandalism to his surgery performed by some members of the same population..

The 'local candidate' trope was one that became almost absurd amongst his BME peers as time went on as it was so commonly referred to as a justification for prevention of career advancement that it gradually stopped being a euphemism. Support from the 'establishment' was patchy (more often absent) and in any case silence was felt to be better than speaking out in case one was viewed as 'causing trouble' thereby completely scuppering any hope of stable employment.

When I was applying to medical school in the mid-90s, his experiences of those early days shaped the advice he gave me. "Remember you might think that society has moved on but you will *always* have to be twice as good as any white student/doctor to get the same opportunities."

Maybe the overt, in-your-face racial slurs are uncommon today but it is apparent that the prejudice and biases have mutated today. Disparities in care quality and outcomes for BME patients persist and BME representation in NHS leadership is scant as a quick scan of board membership of the majority of NHS trusts and certainly national bodies reveals. The NHS staff surveys repeatedly highlight an increased prevalence of bullying and harassment amongst staff from minority groups and sits in a wider national climate that does not cultivate equal opportunity or equitable treatment of BME groups (eg. Bawa-Garba, Windrush, the 'hostile environment')

I am hopeful that the NHS can move forward and beyond gestures such as tokenistic BME appointments for strategic purposes and diversity/equality quangos without any real reach or impact, to an acceptance that there is a problem and motivating people to actually be a catalyst for change. For certain this catalyst does not take the form of another policy paper of which there have been several (it has been 4 years since the publication of Kline's Snowy White Peaks report).

Until then it is the duty of those of us who identify as BME to continue to raise awareness and call out overt, structural or implicit racism wherever and whenever it arises. It is also our duty to mentor the next generation of healthcare professionals to be able to do the same and provide the positive role models that the author and my father's generation lacked.

Competing interests: I am BME

07 June 2018
Partha Das
Nephrologist/Harkness Fellow