Dealing fairly with racist patients
BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6575 (Published 19 November 2019) Cite this as: BMJ 2019;367:l6575
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It’s very helpful to start the discussion on this issue of dealing with racist behaviour in the context of duty of care. Using an analogy from a sports model only has a limited relevance to the healthcare settings. As playing a sport is not a basic human right but access to treatment is.
Similarly, duty of care for players is significantly lower than physically or mentally unwell people. Does that mean that NHS staff has to put up with this racist abuse from patients & carers? My answer to that is, No, not at all. We should stick to the NHS Zero Tolerance of Abuse policy and if that results in withdrawal of services or reporting to the Police, it should be done as deemed appropriate to a particular situation. However, a fair & proportionate response must have two components--
1: An element of oversight on such decisions by a group of individuals with relevant experience & ability to do a dispassionate & objective review.
2: It’s not the intention of the accused but the impact on the victim of reported abuse which matters the most. We should have a mechanism to ensure the affected staff members are properly listened to & supported if they report or are noticed to be the subject of such abuse.
Healthcare services are only sustainable as a public service if our staff feel well supported & valued coming to the workplace to serve to all people. Racist abuse should not be tolerated at all as it not only demoralises the affected staff, it renders our cherished NHS unsustainable.
Competing interests: No competing interests
Re: Dealing fairly with racist patients
Daniel Sokol will know there is no justification defence for acts of direct discrimination. Much of the overt acts of racism which Sokol refers to and NHS staff experience, fall into this category; s13, Equality Act 2010 deals with direct discrimination and s26 with harassment. In my experience, most of the overtly racist acts by patients are committed in the presence of witnesses, usually colleagues and/or patients. So Sokol should not be overly concerned about the evidentiary burden and moreover, it is extremely unlikely that any BAME professional would make a false allegation in relation to an overtly racist act. Hence, Sokol’s attempt to compare with a football match scenario or video evidence to satisfy the evidentiary burden seems to be a rather disproportionate one.
It is the proportionality of the sanction for racist acts which should be main issue. We must not forget, the doctor-patient relationship could be properly terminated as per GMC guidance and overt racism per se with or without hostility/violence seems a reasonably sufficient ground to do so. It is indeed unlikely, that any doctor who ends such professional relationship would ignore the express obligation to handover the care of the patient to an alternative professional. However, making such alternative clinical care could understandably lead to delay and inconvenience; surely, perpetrators of such racist acts will have to bear responsibility for the consequences of their unwise and unlawful acts. Nor should Sokol worry about ‘appeal’ rights of the perpetrators as there are ample procedures within the NHS for patients to complain and appeal.
Doctors are generally familiar with mental capacity issues (particularly those who work in psychiatric and A & E settings) and therefore, Sokol should be reassured that mental capacity of a floridly psychotic, an intoxicated or intellectually impaired patient-perpetrator would be fully taken into account when considering any sanction. Regrettably, in my opinion, racist acts are still underreported and downplayed within the NHS, particularly within psychiatric services.
Competing interests: No competing interests