Racism is a problem in the health service – whether you see it or not

Doctors in Northern Ireland face racist behaviour every day. It’s time we acknowledged that, writes junior doctor Maysah Salman

Location: Northern Ireland
Last reviewed: 17 June 2022

Over the last few years I have found there are many challenges when working in the Northern Ireland health service: the horrendous waiting lists, the busy emergency departments, rota gaps and not least the lack of a government taking decisions and planning for the future.

But what I can also see is there is a problem with racist behaviour. Like me, you might not have been on the receiving end, but you may have witnessed it in your workplace. In Northern Ireland there is a tendency to focus on political or religious differences as if they are they only ones that matter, but racism and racist behaviour is just as bad and must also be acknowledged and addressed.

Recent BMA research found that of respondents from Northern Ireland, 85% had experienced racism within the last two years – higher than in the other nations – and shockingly, 26% of respondents had considered leaving their job because of racist behaviours.

Racism isn’t always overt, like what this member says they witnessed: ‘I heard a consultant and a registrar calling an Asian colleague a monkey behind her back and laughing about it.’

It is more likely to be less easy to see: ‘Racism is often subtle, to the point that the white people I tell about it don’t register it as racism, while fellow brown people understand instinctively what happened.’

Every doctor working in our health service should have the same opportunities and be treated with the same level of respect – this means right from students on placements up to consultants – but responses to our research disappointingly found this was not the case.

Experiences of students in Northern Ireland were not positive. ‘[There was] difference in treatment when seeking help or when asking for teaching opportunities. There was an obvious difference in the way my white colleagues were treated when advice was sought from specific seniors.’

‘Some doctors give more attention and opportunities with patients to students who are from Northern Ireland. When they explain concepts, they look and engage with my Northern Irish colleague rather than me and my other European colleague. One instance when I took a history from a patient, although I was asking the questions, the patient would look and answer to my Northern Irish colleague.’

Many of the respondents who were working as doctors also said they were negatively viewed before they had even examined the patient. ‘A couple of encounters when people assume that my English isn’t good before I get a chance to speak; another scenario is when people think you’re not a good doctor till you start to prove yourself because of the colour of your skin.’

‘Micro aggression and attitude differences. Also, false assumption about my capability. Intensive judgments and microscopic dissection of my clinical judgement.’

‘The second people find out where I studied their approach / demeanour changes regarding my competence. As though challenging my clinical acumen. If I do not speak, the assumption is that I am a foreigner, they will address white members of staff despite my seniority. I often get mixed up with other black colleagues – three individuals who do not share heritage, body shape or accents – on multiple occasions by a wide array of staff, including consultants, senior nurses and bed managers.’

Many of the respondents said the behaviour they saw and experienced had a negative effect on their mental health. ‘I find myself stressing and working harder to achieve the same result my white counterpart will do with not much effort. This makes me sad, tired and discouraged.’

The comments made by our colleagues in this research make for shocking reading. We must all do better as individuals and as employers. We need to recognise and acknowledge that there is a problem with racism and racist behaviour right across our health system, and that our colleagues are being harmed.

Read the report: Delivering racial equality in medicine

Maysah Salman is deputy chair of the BMA Northern Ireland junior doctors committee