‘I used to be very vocal and speak out on issues that I thought could be changed to improve patient safety or staff working conditions,’ says Purab Singh.*
‘Now it’s the case that, even though I might want to say something, I worry that it might cause problems or maybe I might upset the wrong people.’
When Dr Singh first came to the UK from India to work in the NHS, he did so full of confidence and belief in both his clinical and language skills, and with an eagerness to help patients and further develop his knowledge and experience.
However, his experiences as a registrar at his first NHS workplace, during which he says he faced numerous accusations of having poor communication skills, have shaken that confidence and even changed the way he approaches his job.
Dr Singh’s problems first began after he had raised concerns about how notes on patients were being recorded differently by separate health professionals. Following this he says his educational supervisor called him over and suggested that it was in fact he who had the difficulty in communicating.
‘As far as I was concerned, as an international medical graduate you have to demonstrate your proficiency in English before you even take a medical exam to prove your clinical skills,’ Dr Singh says.
‘I felt that it was a way just to silence me, but took it in my stride during my appraisal and said that I was ready to do a communication skills course just to show that I was continuing to try and improve my communication.’
He progressed through his second year without any further feedback being raised about his communication skills, up until the very end of his final post when his clinical supervisor told him he had ‘communication issues’.
When he pressed for details and specifics, he says he was met with vague examples and hearsay, and then felt as if he was being pressured into accepting something that he did not agree with.
After his appraisal was completed in his absence, he complained to his deanery and notified the BMA, with the former accepting that his appraisal should not have been completed in absentia, and Dr Singh progressed to his third year. Unfortunately, criticisms of his communication style persisted, and he began to feel he was being singled out and picked on.
He was told by his clinical supervisor that a clinic letter he had written had been too brief and therefore an example of bad communication.
‘I said, “Did the GP complain about this letter? Did the patient?”, she said no,’ Dr Singh explains.
‘It felt like she was going through all my correspondence in order to find something that could be considered a problem.’
It was at this time he began to suspect that racial discrimination or unconscious bias might behind the claims of poor communication, particularly after seeing how outspoken doctors from EU backgrounds, including some without English as their first language, did not appear to face similar accusations.
‘They were very outspoken in team meetings, but nobody accused them of communication issues,’ Dr Singh recalls.
‘It felt like I was expected not to be outspoken but submissive, so I felt like there was racial stereotyping there.’
It was at that time that he decided to raise a complaint about bullying and racial discrimination, and to begin exploring the possibility of being transferred to a different trust. During this dispute Dr Singh tragically learned that one of his parents back in India was terminally ill, something that added further mental strain to an already difficult situation.
Matters escalated when he was asked, with less than 24 hours’ notice, to attend a meeting at which representatives from his trust’s HR would be present.
After pointing out that he had not received enough notice to arrange for a BMA adviser to accompany him, he declined to attend the meeting, a decision for which he was subsequently threatened with disciplinary action.
With BMA help, and support in raising his concerns and endeavouring to resolve matters constructively, he was able to move to a new trust and eventually obtain his CCT, and when there, learned that his former one had begun an internal review into his complaints.
‘Within days of my parent passing away, the employer bombarded me with multiple questions about the internal review,’ he says.
‘They asked me to respond in writing despite being aware that I was arranging a funeral abroad while suffering from an accident which had fractured my hand.’
But Dr Singh chose not to participate in this process after discovering that the person chairing the investigation was someone against whom he had raised a grievance for bullying and discrimination.
He also discovered that his most recent appraisal had not been approved by his previous employer, something that he knew would hinder his progression at his new place of work. It was this that led to him to take his former trust to an employment tribunal.
Eventually Dr Singh reached an agreement with his former employer in which he would withdraw his case provided that members of senior management at the trust committed to undertaking training in unconscious bias, a request that they eventually acceded to.
While he never sought financial compensation he says he also did not receive any apology from his former employer.
While admitting that his experience has been a damaging and traumatic one for him, especially for his mental and emotional health, Dr Singh says that he has no regrets about fighting his case, which he hopes will help to highlight the issue of racism within the health service.
‘The reason I went through all this was so that nobody else has to undergo the same kind of treatment,’ says Dr Singh.
‘I wanted to reinforce the point that being vocal is not automatically a communication issue.’
The BMA will fully support members with similar concerns about their treatment and advise and help them to use the appropriate routes.
* Names have been changed
On The Ground is a regular column in The Doctor that highlights practical help given to BMA members in difficulty