Don’t call me Bibi—or anybody else, for that matterBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m535 (Published 11 February 2020) Cite this as: BMJ 2020;368:m535
- Fizzah Ali, neurology registrar
- Follow Fizzah on Twitter @DrFizzah
As medical students, our vocabulary expands exponentially to accommodate written exams and clinical assessments, but nothing prepared me for the slang I encountered on the wards in my foundation years. It was here that I first came across the term “Bibi-itis.” A decade later I found it was still being used.
It happened in the doctors’ office. I was scrolling through a list of patient referrals on my computer wondering out loud what undiagnosed entity awaited me in the emergency department. Beside me, my colleague asserted that the crucial diagnostic clue could be found in the patient’s name. In fact, he went on, that based on my race and my gender, if my name appeared on a list of patient referrals it would herald an upcoming case of “Bibi-itis.” I turned to my registrar colleague and silence hung between us for a few seconds as I contemplated an appropriate response.
I have a tendency to brush microaggressive comments away without too much evaluation. But today was different. Things escalated, voices rose, I accused him of prejudice, and I was accused of ignorance in return. I felt shaken. A registrar bystander remained passive throughout, making me question my reaction.
“Bibi-itis” or “Mrs Bibi” is a derogatory term, derived from the surname “Bibi.” It refers to female patients of south Asian heritage who are said to present with exaggerated subjective complaints, backed up by few objective findings. Usually, the term is applied to older women with limited English. It’s also used more widely, referring to seemingly inexplicable complaints in south Asian women. It’s used by white doctors as well as those from minority groups. In part, the use of the term is compounded by the belief that older Asian women express psychological distress through physical symptoms. The term serves as an example of casual clinical stereotyping that can cause unrecognised bias leading to missed diagnoses, delayed treatment, and preventable unwanted outcomes.
Consider, for example, the dogged pursuit of tuberculosis in an Afghan woman. A biopsy eventually shows a rare tumour affecting her central nervous system, but also poor prognosis, ethambutol induced optic neuropathy, and disability. Then there is the Afro-Caribbean woman presenting with whole body pain. An initial assessment leads to a presumed diagnosis of a functional disorder. But the following day the woman is transferred to intensive care with Guillain-Barré syndrome, where she is appropriately treated. But her care does little to persuade her family that she is in capable hands.
The situation I found myself in illustrates how women from minority groups within the medical workforce can be marginalised and how this in turn can translate into the marginalisation of women patients. Racial bias in clinical encounters is rarely discussed on the job. Doctors want to be accused of racism as much as they want to be accused of negligence. But the privilege of our professional position demands a wider consideration of uncomfortable topics. A starting point is self-reflection and awareness, teemed with the containment of infectious behaviour. The viral use of racist terms serves as one example. Approaching patients as people and not patterns reflecting prevalence figures is also important.
The term “Bibi-itis” has no place in the medical, or any other, environment. It profiles a group of women through a lens of prejudice, many of whom may already be disadvantaged by society. It undermines the delivery of clinical care, reinforces perceived differences, and consolidates barriers.
Let’s ditch it. Let’s aspire to a higher level of diagnostic skill.
For more articles in The BMJ’s Racism in Medicine special issue see bmj.com/racism-in-medicine