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Diversity and inclusion should be one of the pillars of good medical practice. Teamwork, advocacy, integrity and being respectful of others are essential components of being a doctor(1). This is how to achieve good medical practice and ensure patients can receive the best care possible.
There is evidence suggesting that diversity and inclusivity are not valued in a number of health settings. Where other forms of misconduct and unprofessional behaviour would be investigated and disciplined, there has been frequently a blind eye to racism within the UK medical field, which has been prevalent since the inception of the NHS.
The NHS has colonial roots, with people from colonised nations being given British citizenship in order to build the foundations of the NHS.(2) By 1960, over 40% of junior doctors were brought in from India,(3) and there were active recruitment efforts at the time to source nursing staff from the Caribbean to try and fill the 54,000 nursing vacancies that were present in 1948. (4) From its infancy, the NHS has relied heavily upon those from commonwealth British colonies.
This generation of workers, described as the Windrush generation, were then subject to the Windrush Scandal in 2018, where many were wrongfully detained, denied legal rights, threatened with deportation and some were wrongfully deported by UK home office at the time.(5) This is extremely unjust for the generation who left their home countries to come to the UK and help build the country, addressing labour shortages between 1948 and 1973.
We must look at history and context when looking at topics such as systemic racism(6), like we are experiencing in the NHS. We do not have to look back very long, as these events only occurred in recent times, during ours and our parents’ lifetimes.
The statistics which show that ‘UK universities recorded 560 complaints of racial harassment over three and a half years, while 60,000 students said that they had made a complaint’(7) is proof that racism is not taken seriously. Medical students often fail to escalate a concern due to the worry that their claim will not be taken seriously. This statistic shows that this is a valid concern.
Dismissal following racist incidents both on campus and on clinical placement leads to the alienation and isolation of students from their wider peer groups. Consequently, students from ethnic minority backgrounds may be less likely to engage with support, if there is no meaningful change available. This impacts longer term mental and physical health.(8) This may culminate in the presentation of attainment gaps which are observed throughout medical training.(7)
This serves as multiple extra hurdles in an already gruelling training process for a trainee to overcome, resulting in an inequality in the quality of education received. Consequently, students then feel the responsibility to shoulder their trauma to help others, offering the support that they needed themselves. This has been shown during COVID-19 with the increase of student-led peer-support groups within universities that are doing their own work outside their studies to fill the gaps in the system.(9)
It is crucial that everyone engages in anti-racism, and it should be taken as seriously as an essential pillar of good medical practice. It is only when racial inequality is viewed as a regulatory matter bound by official GMC guidelines, that there will be meaningful change. A simple change in regulation and its subsequent implementation will be transformative in efficacy for the future generations of doctors and the future of patient care.
Doctors' regulations and policies should include anti-racism as one of the central pillars of good medical practice
Dear Editor
Diversity and inclusion should be one of the pillars of good medical practice. Teamwork, advocacy, integrity and being respectful of others are essential components of being a doctor(1). This is how to achieve good medical practice and ensure patients can receive the best care possible.
There is evidence suggesting that diversity and inclusivity are not valued in a number of health settings. Where other forms of misconduct and unprofessional behaviour would be investigated and disciplined, there has been frequently a blind eye to racism within the UK medical field, which has been prevalent since the inception of the NHS.
The NHS has colonial roots, with people from colonised nations being given British citizenship in order to build the foundations of the NHS.(2) By 1960, over 40% of junior doctors were brought in from India,(3) and there were active recruitment efforts at the time to source nursing staff from the Caribbean to try and fill the 54,000 nursing vacancies that were present in 1948. (4) From its infancy, the NHS has relied heavily upon those from commonwealth British colonies.
This generation of workers, described as the Windrush generation, were then subject to the Windrush Scandal in 2018, where many were wrongfully detained, denied legal rights, threatened with deportation and some were wrongfully deported by UK home office at the time.(5) This is extremely unjust for the generation who left their home countries to come to the UK and help build the country, addressing labour shortages between 1948 and 1973.
We must look at history and context when looking at topics such as systemic racism(6), like we are experiencing in the NHS. We do not have to look back very long, as these events only occurred in recent times, during ours and our parents’ lifetimes.
The statistics which show that ‘UK universities recorded 560 complaints of racial harassment over three and a half years, while 60,000 students said that they had made a complaint’(7) is proof that racism is not taken seriously. Medical students often fail to escalate a concern due to the worry that their claim will not be taken seriously. This statistic shows that this is a valid concern.
Dismissal following racist incidents both on campus and on clinical placement leads to the alienation and isolation of students from their wider peer groups. Consequently, students from ethnic minority backgrounds may be less likely to engage with support, if there is no meaningful change available. This impacts longer term mental and physical health.(8) This may culminate in the presentation of attainment gaps which are observed throughout medical training.(7)
This serves as multiple extra hurdles in an already gruelling training process for a trainee to overcome, resulting in an inequality in the quality of education received. Consequently, students then feel the responsibility to shoulder their trauma to help others, offering the support that they needed themselves. This has been shown during COVID-19 with the increase of student-led peer-support groups within universities that are doing their own work outside their studies to fill the gaps in the system.(9)
It is crucial that everyone engages in anti-racism, and it should be taken as seriously as an essential pillar of good medical practice. It is only when racial inequality is viewed as a regulatory matter bound by official GMC guidelines, that there will be meaningful change. A simple change in regulation and its subsequent implementation will be transformative in efficacy for the future generations of doctors and the future of patient care.
References:
(1) Good medical practice - GMC (no date). Available at: https://www.gmc-uk.org/-/media/documents/good-medical-practice---english... (Accessed: March 26, 2023).
(2) McKee, M. (2018) Lessons from the Windrush Generation, The BMJ. British Medical Journal Publishing Group. Available at: https://www.bmj.com/content/361/bmj.k2017.full (Accessed: March 26, 2023).
(3) Birvins, R. (2019) The Windrush Generation and the NHS: By the numbers, People's History of the NHS. Available at: https://peopleshistorynhs.org/the-windrush-generation-and-the-nhs-by-the... (Accessed: March 26, 2023).
(4) Bonner, K. (2020) Windrush and the NHS – an entwined history, NHS England. NHS. Available at: https://www.england.nhs.uk/blog/windrush-and-the-nhs-an-entwined-history/ (Accessed: March 26, 2023).
(5) Hewitt, G. (2020) The Windrush scandal, Taylor & Francis. Caribbean Quarterly. Available at: https://www.tandfonline.com/doi/abs/10.1080/00086495.2020.1722378?journa... (Accessed: March 26, 2023).
(6) Jeraj, S. (2021) Doing the work to end health inequalities caused by systemic racism, The BMJ. British Medical Journal Publishing Group. Available at: https://doi.org/10.1136/bmj.n821 (Accessed: March 26, 2023).
(7) Kmietowicz, Z. (2020) Are medical schools turning a blind eye to racism?, The BMJ. British Medical Journal Publishing Group. Available at: https://www.bmj.com/content/368/bmj.m420 (Accessed: March 26, 2023).
(8) Williams, M.T. (2018) Assessing racial trauma with the Trauma Symptoms of Discrimination Scale., American Psychological Association. American Psychological Association. Available at: https://psycnet.apa.org/doiLanding?doi=10.1037%2Fvio0000212 (Accessed: March 26, 2023).
(9) Abrams, M.P. et al. (2022) Impact of providing peer support on medical students' empathy, self-efficacy, and Mental Health Stigma, International journal of environmental research and public health. U.S. National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099875/ (Accessed: March 26, 2023).
Competing interests: No competing interests