Ethnic minority staff and patients: a health service failureBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2226 (Published 21 May 2019) Cite this as: BMJ 2019;365:l2226
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I look forward to this special issue, in particular further information regarding attitudes towards NHS staff in terms of complaints which can be arbitrary and dependent on bias (conscious or not).
A cursory look at the results of a google image search for the term “doctor” reveals a disparity between expectation and reality. Of the first 10 healthcare professionals that appear, every single one appears to show a someone who seems to be from a white background.
Of course, we have to bear in mind that the image search is likely to include a high proportion stock images where advertising companies use photo models to portray doctors. Nevertheless, such imagery is pervasive throughout our society, whether it is online, on television or in advertising.
Is it therefore surprising that when patients do access healthcare, their preconceived image of what a doctor should look like can be very different from their actual experience? Do mismatches between expectation and reality increase the likelihood of a complaint?
Perhaps even more pernicious is the effect such imagery could be having on potential medical school applicants who may feel they have to conform to such stereotypes to gain access to the club (or not bothering to apply at all).
Competing interests: Blogger at https://unexaminedmedicine.org/
Checking the Government website today (www.gov.uk), it gives this overview of the duty of equality across public services including the National Health Service (NHS):
"The public sector Equality Duty (PSED) requires public bodies to have due regard to the need to eliminate discrimination, advance equality of opportunity and foster good relations between different people when carrying out their activities."
Poorer quality care for patients from ethnic minorities has been documented in many British institutions. In this letter I will focus on the inequalities experienced by clinicians from Black and Minority Ethnic groups (BME). A wise colleague (and fellow teacher) told me this starts long before BME professionals are in practice. So I began by looking just one step before professional practice. To qualify in the UK, clinicians all spent extended periods in higher education. Recent research in two multi-disciplinary London universities by AdvanceHE  was driven by the same need to enhance diversity at the top of organisations described in this Editorial. Discrimination is already present in academia. However, participants in a Diversifying Leadership programme reported “that using diverse role models and speakers can help convey the message that leadership can take many forms and can incorporate different identities and cultural backgrounds.” Equality of recognition and promotion came up as sensitive issues for many BME staff. Over the year of the Diversifying Leadership programme, ratings of “My formal appraisal/performance review is useful/ valuable” improved significantly.
Here are three recommendations for developing new academic leaders, that might also apply to the NHS:
a. Pay particular attention to the advertising strategies employed for senior posts, identifying ways to increase the breadth of the audience reached.
b. Initiate discussions with BME staff to explore what barriers they face to progression and leadership within the institution and more broadly.
c. Implement equality impact assessments as a standard accompaniment to all decision-making agenda items.
Actually, these recommendations are a Duty.
1. Kmietowicz Z, Ladher N, Rao M, Salway S, Abbassi K, Adebowale V. Ethnic minority staff and patients: a health service failure. BMJ 2019;365:l2226
2. Fook J, Archibong U, Kim T, Aldercotte A. Cracking the concrete ceiling: Tracking the impact of the Diversifying Leadership programme. London, AdvanceHE, 2019.
Competing interests: No competing interests
It would be interesting to see what the special issue turns up.
I have always classified myself in questionnaires from the DHSS, from the local authorities, etc, as merely Homo sapiens and crossed off the dozen or so boxes asking, in effect, whether one is a green man or blue.
Census forms? I treat them the same - with contempt.
I am sure that the health service has sometimes attributed to me an “ethnicity” without consulting me.
Just in case someone wishes to gift to me the tartan of the Clan Annand or Anan - I will accept it with thanks, but I would like to clarify that my ancestry does not include any Scottish chromosomes. As far as I know.
Competing interests: No competing interests