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If you are a BME doctor you are in for a bumpy ride.
Decades of British differential attainment research has shown you are more likely to fail your postgraduate medical examinations and appraisals, be bullied and undermined, contract mental illness, enter formal disciplinary process and for those with the added bonus of being international medical graduates, have all this escalate to GMC sanctions and warnings.
We know all this, because we have researched ‘race’.
But what if you have multiple protected characteristics? Let’s say you are an international, BME, female, Muslim doctor? How do these multiple identities combine amidst interlocking systems of power?
Hadiza Bawa-Garba is someone who embodies all of these characteristics, and her case proved to be the catalyst for the BMA’s race equality summit I attended in July. A case that lost us a beautiful young boy Jack Adcock, challenged the GMC and struck fear into the hearts of junior doctors.
Jack’s death is the price that we pay when we ignore systems errors and human factors.
The holes in the Swiss cheese were unfortunately aligned that fateful day and while most have subsequently been examined, except for the intersecting factors of race, gender and religion.
When we fail to acknowledge intersectionality, we fail to mitigate for it.
Gender inequality in medicine is well recognised, whether it be the gender pay gap, under-representation at senior levels or greater reports of undermining.
According to the Kings Fund, NHS staff from all religions report discrimination but this is by far the highest amongst Muslims a group also under-represented at senior levels of the NHS.
The same challenges exist for those of other protected characteristics such as disability and sexual orientation.
What if you are the Venn diagram? How do layers of inequality cumulate and what impact does this have on the individual and the organisation?
How did Dr Bawa-Garba end up in a position for which she was inadequately prepared, and how easy would it have been for her to seek help or speak out, given that the culture towards people who have done so has often been less than supportive?
Indices present another opportunity to engage leaders. Stonewall’s Workplace Equality Index has begun to change the landscape for LGBT employee inclusion. The Workforce Race Equality Standard is bringing important information to light and starting essential conversations.
A faith equality index could represent an important turning point for the NHS and a cause for introspection, yet how many medical organisations collect faith data?
Race is inadequate as a proxy indicator for faith. Without this data we fail to acknowledge intersectionality and we fail to mitigate for it.
Yet we already recognise race and gender as risk factors. Why, then, do we not routinely support BME women earlier in their training?
Targeted interventions might include signposting workplace mentors, ensuring continuity of clinical and educational supervision and offering safe, reflective spaces for sensitive discussions on race and inclusion.
Have we succeeded in delivering inclusive leadership and psychological safety at work? Can everyone truly bring their ‘whole selves’ to work?
Assertiveness training may help BME women but we must not under-estimate the collective responsibility of facilitating the speech of truth to power.
Patient safety and staff inclusion are intimately bound together. We cannot have one without the other, however hard we medico-legalise the problem.
Let us not wait until another Jack Adcock before we implement solutions.
Emma Wiley is a microbiology registrar at University College London NHS foundation trust and a member of the British Islamic Medical Association
Excellent points that need to be addressed.
Adding to what is mentioned here is the "Fitness to practice referrals" clear inequalities as well as inequalities in passing the membership examination, PLAB examination, job interviews selection & appointments for BME. If you are unlikely enough to have multiple identities then your life in Medicine will be problematic.
If we as a society fail to ask our self why these inequalities still exist in contemporary medicine without everybody asking him/herself what is
my responsibility in addressing them or even suggesting some solutions then we all will be "shooting our self in the leg" without even realising that.
Dr Amer Hamed
This raises some important points. The question "what if you had multiple protected characteristics? " makes it sound like the protected characteristics of race, gender and religion only apply to some people, whereas surely they pertain to everyone?
The evidence we have suggests that female gender, BME race, faiths/religions such as Islam or Sikhism and those that have these protected characteristics are particularly high risk for undermining/bullying, mental health and experiencing the effects of inequality both within and outside of the NHS. So yes most people have a gender, race and faith or no faith but the impact of inequality may be experienced differently.
Note that the protected characteristic in the Equality Act is sex, not gender.
The worse thing is that all of these cannot be proved legally successfully . The law is so strict in it's interpretation. Also people rarely go to Tribunals after having such experiences. I think we the BME staff of NHS must accept that forever we will be treated as second class citizens.
I agree the wording is a bit woolly. Clearly some of the protected characteristics could apply to anyone, depending on the situation. The Equality Act just means that legally you are not allowed to discriminate against someone because of their sex, religion etc. The whole notion of 'intersectionality' is very complex and not really represented in law. It is therefore quite hard to make fair policy on this basis. It also too often ignores discrimination based on social class which I believe is one of the main problems facing the medical profession.
I am a facing a severe bullying and discrimination presently and I dare not speak as there is a big conspiracy once you mention a name ...They form a click and make life very unbearable for you. Instigating fellow junior and senior against u including junior health workers who are not even doctors. Its a big discrimination face bymudkiks females in headscarves worse with a black.femake Muslim in headscarves. I am.one and I witness it everyday. Iam too scared to speak out.
Pls how does one you on the Biritish Islamic medical association.