AIBU to think refusing treatment from non-white medical professionals should have consequences?

[MrsBennetsPoorNervesAreBack]

There has apparently been a significant rise in racism towards NHS staff, with a growing number of people refusing to allow non-white NHS staff to treat them. This is sad but not surprising given the shift in society as a whole towards people expressing their racism much more openly.

https://news.sky.com/story/nhs-staff-experiencing-unconscionable-levels-of-racist-abuse-survey-finds-13569575

I have always admired the commitment of NHS staff who treat all patients with care and compassion, even when those patients are rude and abusive. But if people are actually refusing to let certain staff provide treatment, surely there should be consequences for this?

AIBU to think that everyone has the right to refuse treatment if they so wish, but if a patient refuses treatment from a medical professional simply because they don't like the colour of that medical practitioner's skin, then they should then forfeit the right to receive that treatment on the NHS. So they can either go without or find the money to be treated privately by a medical professional of their choice?

There would need to be signs warning people of the consequences of their choices, of course, but if someone doesn't want a Black or Asian radiographer carry out their x-ray, then fine... they just don't get an x-ray.

Fair enough.

Yes, it was perfectly clear to me and probably most other people on the thread, it was only you who thought your sample of one was relevant in any way.

Absolutely. Thank you for your posts on this thread.

What nuance would there need to be to make calling someone a ‘monkey’ or a ‘dirty foreigner’ acceptable, I wonder?

Why are you strawmanning what that poster said @Switchnow- she’s clearly not justifying calling black people monkeys, and that isn’t just what this is about.

Why is it difficult to accept that the clinicians surveyed might be a better judge than you of whether or not they experienced discrimination? I’m 100% sure that a qualified and licensed medical professional, of any ethnicity or skin colour or nationality, is able to distinguish between genuine ‘sorry, I can’t understand your accent, could you slow down/spell that word out/write it down’ and discriminatory language or actions.

ETA It’s also very easy to read the full report https://www.sor.org/news/trade-union-ir/nhs-staff-face-worsening-racist-abuse-following-ri which includes white medical staff reporting having witnessed racism towards colleagues. Maybe you’ll find it easier to believe them?

“I can’t understand dr w/nurse x/radiographer y/HCA z, so can I see someone else” has the potential to be thinly veiled racism (e.g. they can understand them but want to see someone else so use this excuse) or may be a genuine issue, which could be incorrectly interpreted as racist (especially if you are looking at everything through a prism of suspicion, which is how a heavy focus on this matter is likely to be interpreted- people will fear being seen not to be being proactive or to be ignoring racist incidents)

Another thank you from me for your excellent posts, @jacks11, and the above is precisely the sort of issue many of us have focused on. Clearly no right minded person would support true racism, but how to handle things such as this can be less clear and I really don't think automatic assumptions of bad faith help anyone

It's all going so well isn't it.

I agree it can be tricky, but the blanket assumption that it’s just because the patient is old/doesn’t understand the HCP/is a SA survivor doesn’t help either. Racism exists, it’s a fact and it’s visible if you’re willing to see.

It’s going exactly the way I expected it to. I think I’ve made my point. Thank you to the posters who understand nuance and aren’t gleeful about the suffering of people they disagree with. It’s certainly not unique to this issue. Particularly thank you to the doctors/HCPs who’ve posted for your front line experience and perspective.

I am not saying racism is not experienced by HCP. That would be monumentally stupid to suggest, of course it would be! My point is that it is easy to state in theory, harder to implement reliably in practice and we need to be mindful of unintended consequences for both patients and HCP’s.

I think we can all easily identify blatant racism. I also think it can be possible to misinterpret things, or to interpret it correctly but not be able to prove it (just a case of “that was my impression”). Those latter scenarios are a big problem for HCP’s, especially if you decide to deny care (or state that their request amounts to the patient refusing care) and there are significant consequences for the patient. That could be career ending.

Because I can assure you, when it all goes wrong, the more political side of NHS management will not back the HCP’s up if they get even a whiff that there could be an error in application of their procedures. They will hang them out to dry, rather than blame their own processes.

I wasn’t responding to you but to a specific point made by another poster.

I’m not sure what you mean by ‘implement in practice’ - implement what? If you’re referring to denial of care I haven’t suggested that, and neither is it suggested by the OP or the SoR. ‘The SoR is therefore placing renewed focus on holding NHS trusts accountable for incidents of racism, so that they not only record the incident, but also monitor how it is dealt with and work with trade unions as necessary. ‘

Yes, I imagine this happens quite a lot. I've seen it with my own dad who could not understand what a HCP was telling him because of her heavy Jamaican accent, despite him repeatedly saying 'pardon' and repeating his questions several times.

He did not complain or ask to speak to someone else. No doubt people do complain or ask to see someone else due to racism. But I suspect there are many instances of patients not understanding a HCP but just putting up with it, even to the detriment of their own health and wellbeing.

Real life is complicated.

Wasn't there a plan for all this when our betters decided everything had to be globalised? Isn't it in the diversity is a strength manual?

There are 200 nationalities working in the "national" health service. There's 200 nationalities using the service.

We are dealing with 40,000 unique combinations of nationalities.

Where are you getting these figures from? The UN only recognises 197 countries, and most ethnic communities are in pockets. It’s unlikely a Burkinabè will encounter a Samoan and have an unsatisfactory experience.

I stand corrected: from Google ai
UK Parliament briefing documents do track exactly 216 unique geographic classifications, they do not publish a single raw list of all 216 individual percentages in their standard public briefings. Listing every single entry would result in over 150 nationalities showing up as a rounding error of 0.01% or lower(consisting of countries or territories with only a handful of staff members). 1]

So really, about 50 nationalities. And even then, the majority by some margin are British:

The Macro Breakdown (100% of the NHS Workforce)

• British Nationality: 78.7% 1]
• Total Non-British Nationalities: 21.3%
• Asian Nationalities: 8.6%
• EU Nationalities: 5.2%
• African Nationalities: ~4.5%
• Americas / Rest of World: ~1.7%
• Unknown / Unrecorded: 1.3% 1, 2]

Which one would be called racist?

I know, sorry if I did make that clear. I was more responding to your point.

Anyway- implementation is exactly what I said. Easy in cases of obvious racism- agree there may well be improvements to be made regarding recording and management.

However, the difficulty in implementation I was referring to are the less clear cut cases- how do you manage them? And the OP did directly state that patients who behave in a racist manner towards HCP’s should be treated as though they have refused to be treated- I.e. they will not receive treatment. If a patient says “I’m not declining treatment, I just want treatment from a different HCP” but the HCP decides that they have been racist and so refuses an alternative HCP, which then results in no care being provided- I think that is sliding rather close to denial of care, if it isn’t outright denial of care (albeit only relating to that episode of care).

Perhaps I am not explaining myself well. I think I would be very concerned about having to make a decision based on my, or a colleagues, interpretation or impression of whether something is racist or not. It’s easy if someone uses racist or abusive language, for instance. But there are more subtle ways of being racist which create an impression or feeling but if written down might look less obvious. Would I be expected to make a judgment in a care where there was a strong suspicion of racism, but not obviously racist language, if you know what I mean? I’ve certainly experienced it, but if asked to justify it would be more “this is how I felt/gave me that impression”. How would I record that? Would it be accepted if the patient complained or there was a negative outcome?

What exactly is she talking about? What has Rudakubana got to do with NHS staff being racially abused? (Oh no sorry, not being able to understand what staff are saying due to their accent and cultural nuances).

You get used to her posts and learn to skip them.

quod erat demonstrandum 😁

🤣 thank you, I don’t think I’ll come back to this post. It’s a lost cause. I’m just eternally grateful for the NHS and my family have been served outstandingly well with the majority of consultants being from abroad. A bit of grace, patience and humanity go along way in accepting care.

Sorry I just don’t follow what you mean by implementation - implementing what exactly? Do you mean responding to situations? As you pointed out earlier - and I agreed - there are times when it’s easier to simply accommodate a patient with their request. And sometimes it isn’t, and then they have a choice of what do do next.

I haven’t read the SoR’s recommendations in full but I think their point is that there is a lack of guidance on how to handle these situations so their members - and other HCPs, of which I assume you are one - don’t know how to respond and are potentially at risk of making wrong decisions that either are unfair to patients or don’t protect the workforce.

IME of working in non-medical setting, incident recording can be useful to identify themes or patterns. It’s not about pointing fingers or resolving issues, because there should be existing processes for that. But if we have a particular problem recording relevant situations could be helpful for reflecting on it and finding solutions.

So, if we take communication as an issue, noting that Patient A finds it hard to understand Dr X, who is South Asian heritage, but is fine with Dr P who is Black British, might be helpful. If we find that patients of all ethnicities find it hard to understand Dr X, then maybe we can consider how to help Dr X communicate better. Alternatively we might find that Patient A is in fact using language as a way to access a white doctor only. We could consider raising that with her to understand and meet her needs.

I missed some of your points. I think if a patient is racially abusive they should be asked to leave, other than in a medical
emergency where their life is at risk. They can make a new appointment, I guess it’s up to the practice/clinic if they can see a white clinician but I’d think it reasonable to refer them elsewhere. What message does pandering to them send to either the workforce or the other patients (of any ethnicity)?

It's possible that British people are aware of your contempt for them, hence the difference in our treatment. I've always been made to feel welcome.

Just to add, the survey includes testimony from white clinicians who have witnessed racism against colleagues. You might feel concerned about making decisions but I’d be concerned if I was a colleague of yours that you might be too timid or disbelieving. You give the benefit of the doubt to possibly misunderstood patients, but seem uncomfortable with the idea of defending possibly abused colleagues.