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Views And Reviews The Bottom Line

Partha Kar: Let’s not make excuses for prejudice

BMJ 2019; 365 doi: (Published 18 June 2019) Cite this as: BMJ 2019;365:l4234
  1. Partha Kar, consultant in diabetes and endocrinology
  1. Portsmouth Hospitals NHS Trust
  1. drparthakar{at}
    Follow Partha on Twitter: @parthaskar

It’s not actually the overt comments that really hurt. At least things are out in the open—in your face, even. They may be unpleasant, but you can choose to stand up to them or walk away. What’s worse is the seeping undercurrent, festering beneath the surface. It’s never in your face, but it’s always there.

I’m talking, of course, about racism. It’s well and truly alive in our society, the NHS, and the medical profession, lurking around a corner with a smirk, a nudge, or a nod.

I’ve worked in the NHS for over two decades, and attitudes to race have changed in that time, though perhaps only marginally. What used to be overt is now more polished, but it’s still there. Twenty years ago, when applying for a specialist training job in Wessex, I was told, “People of your type are better suited to applying in Birmingham.” Last year, when pushing a clinical commissioning group to improve patient access to technology as part of my national role in diabetes, an executive suggested to me that “maybe you don’t understand our culture.”

As doctors and healthcare professionals, do we experience racism from patients too? Yes, but we have a responsibility to care for and look after patients, and we can draw the line when they’re abusive.

But what should we do in the face of racism from fellow professionals? We can keep looking on with a wry smile as, with clockwork efficiency, the cycle repeats: the NHS churns out yet another document on equality, makes yet another pledge on diversity, and then shakes its head when yet another dataset demonstrates the lack of any headway.

The latest phenomenon is even more irksome—the acceptance of racism by people arguing for the need to protect “free speech.” We need to acknowledge that the idea of defending free speech has been co-opted by bigots, homophobes, and misogynists to let them share their views in public.

Free speech is the ability to criticise wrongdoing, or people in power, without fear of reprisal. It’s not the freedom to say that we hate gay people or that brown people make us uneasy. That isn’t free speech: it’s an inability to accept modern society moving to a fairer world. We hear rational people suggesting that, in the interests of free speech, we shouldn’t try to impede the spread of bigotry.

Here’s a clear statement from someone who isn’t white: I don’t want to have a debate on whether my skin colour makes others uneasy. That categorically sucks.

So, what can be done? I suspect that some people will never change. But perhaps it’s worth restating that arguments for free speech are too often used to excuse prejudice. Many of us aren’t keen on having another debate to prove our worth to the system. So, please stand by us, and stop the acceptance of prejudice: as a society, we must be better than that.

My parents used to work here, and they always carried the ambition of my training and becoming a consultant in the UK. Whenever something controversial has come up they’ve asked me to be “careful,” because “in the end, you don’t belong”—a view perhaps prejudiced by their own experiences in the early 1970s.

Nearly 50 years later, I’d like the NHS to prove them wrong for me: I like to think that I do belong. Don’t I?


  • Competing interests: I am associate national clinical director for diabetes with NHS England.

  • Provenance and peer review: Commissioned; not externally peer reviewed.