Managing discrimination from patients and their guardians and relatives

Introduction

Location: UK
Audience: All doctors
Last reviewed: 1 March 2022
Topics: Equality, diversity and inclusion

We know from our members that far too often when they experience abuse and unlawful discrimination there are no clear supportive pathways.

Employers have a duty of care to support doctors when faced with an abusive patient or their guardians/relatives.

This guidance gives background information and steps that all employers and healthcare workers should take when incidences of discrimination against a healthcare worker occur.

Some of the references in this guidance relate specifically to England, however the legislation and principles presented are equally relevant to Scotland, Northern Ireland and Wales.

This is new comprehensive guidance targeting this form of discrimination from a third-party in a healthcare setting, so we are open to feedback and adapting the guidance as we learn.

Key principles

  1. All healthcare workers have a right to work in an environment free from abuse, harassment, and unlawful discrimination.
  2. Employers should take active and explicit steps to protect their staff from abuse, harassment, and unlawful discrimination. This should involve the police and social services where appropriate.
  3. The impact of discrimination on doctors should be acknowledged and appropriate support including wellbeing interventions provided for those who are on the receiving end of abuse and discriminatory behaviours.
  4. All patients have a right to emergency healthcare regardless of their behaviour, where this can be provided safely.
  5. All patients have a right to non-emergency care, but this is conditional.
  6. There are some instances in healthcare where requesting a personal characteristic of a healthcare worker is valid (see Section 5: Exceptions).

Definitions

Assault (which is colloquially taken to include battery) includes any act by which a person intentionally or recklessly causes another to suffer or apprehend immediate unlawful violence. Physical contact is not necessary, merely the belief that you are imminently about to be physically harmed. For example, spitting at someone may be an assault whether it makes contact with the victim or causes fear of immediate unlawful physical contact.

There are several definitions of harassment in criminal, civil and employment law.

Harassment in criminal law is defined as threatening, abusive or insulting words or behaviour that are likely to ‘cause fear of, or to provoke, immediate violence’ or cause ‘harassment, alarm or distress’.

Harassment under the Equality Act 2010 is ‘unwanted conduct related to a protected characteristic’ that:

  • violates someone’s dignity whether it was intended or not
  • creates an intimidating, hostile, degrading, humiliating or offensive environment for the person, whether it was intended or not.

Harassment can also be unwanted conduct that is sexual in nature, termed ‘sexual harassment’.

The protected characteristics are:

  • age
  • gender reassignment
  • being pregnant or on maternity leave
  • disability
  • race (including colour, nationality, ethnic or national origin)
  • religion and belief
  • sex and
  • sexual orientation

Case law has also determined that the following characteristics are also covered: caste, non-binary and gender fluid.

The issue

Discriminatory requests, comments and abuse can be very distressing for healthcare workers and may cause them to feel fearful, uncomfortable, and devalued. Experiencing discriminatory actions and words can lead to short and long-term impacts on doctors’ health, wellbeing and dignity.

Healthcare workers most often work in settings where they engage with people. In the NHS, the NHS Constitution (for England) states that ‘the NHS belongs to the people’. People are diverse, with different genders, ethnicities, religions, beliefs, disabilities, ages, social backgrounds etc. Doctors, healthcare workers and patients all have these diverse and intersectional characteristics. When healthcare workers engage with patients (and their guardians/relatives), they are providing a service, and are expected to be fair, non-discriminatory, non-biased and culturally competent in the care they provide.

During these patient and healthcare worker interactions the expectation is that the patient (and their guardians/relatives) will also show the healthcare worker civility and respect, to enable the worker to do their jobs, resulting in the best healthcare outcome for the patient.

No healthcare worker should be made to feel shamed because of the unlawful or disrespectful behaviour of a patient or their guardian/relative, for example refusing to be treated by them because of their personal and protected characteristics such as, colour, ethnic background, religious beliefs or other personal characteristics.

There are times when, due to a variety of circumstances, patients (and their guardians/relatives) do not show healthcare workers dignity or respect, by presenting unlawfully discriminatory or abusive behaviours or language in their interactions. This can manifest in several forms; a non-exhaustive list of frequently reported examples include:

  • hate crime, defined as an action demonstrating hostility based on race, religion, disability, sexual orientation or transgender identity
  • harassment of any form including sexual harassment
  • making comments about the clinical ability of a doctor related to gender, race, disability etc.
  • making derogatory or discriminatory comments about a doctor’s appearance or behaviour, related to their religion, gender identity, sexual orientation or other characteristics
  • abusively or unreasonably refusing the care of a particular doctor.

For more information about the legal, regulatory, government guidance and a model policy for employers on this topic see the full guidance document.