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In fear of a racist revival

Back of doctor in hospital, 16x9, BMA news cover image

Almost half of doctors who qualified outside the EU feel patients treat them differently, according to a BMA survey. Tim Tonkin considers their experiences, and asks whether the Brexit vote has hardened public attitudes

'Some years ago, I looked after a retired, white male patient – a very nice man who presented me with a bottle of whisky after discharge.

‘[However] his parting comment was: “You are a great doctor and I look upon you like my son. You are as good as a white man.” I know he meant well, but it shows the prejudice inside.’

Such was the experience recounted by one consultant of Indian origin taking part in a recent BMA study on the experiences of international doctors working in the NHS.

The political and social discord thrown up by Brexit has meant the status of, and attitudes towards, overseas doctors and medical students has received renewed focus in recent months.

Many non-UK-trained EU nationals working in the health service feel increasingly alienated and unwelcome as a result of the referendum, with more than 40 per cent who responded to a BMA survey earlier this year reporting they were considering leaving the UK.

However, as well as the impact on EU doctors, the survey – which spoke to more than 3,000 doctors – also focused on the challenges and experiences of NHS doctors whose first qualifications were gained outside the EU.

Particular focus was given to how international doctors feel they are viewed and received by their patients, with the results providing some unsettling findings.


Second class

When asked whether they felt patients treated international doctors differently to UK medical graduates, 49 per cent of non-EU overseas doctors who expressed a preference said yes, compared to 38 per cent of their EU-qualified counterparts.

‘International doctors do a lot to treat patients to the acceptable standard in the NHS,’ one Nigerian-qualified GP said. ‘However, even when we do better and provide more appropriate care than UK doctors, patients are quicker to trust what they are told by UK doctors and seem keen to complain about international doctors, even in similar circumstances.’

One Pakistan-born consultant told the survey that while they had not personally experienced discrimination, they had witnessed it happening to others on ‘hundreds of occasions’.

Other contributors to the survey, such as one Indian-qualified staff, associate specialist and specialty doctor, said that while overseas doctors were sometimes treated differently or even discriminated against, the problem was not necessarily a widespread one.

‘Some patients do [treat international doctors differently] as you can tell from their expression as soon as they see a non-white doctor as the disappointment can be obvious. However, in my experience the number is very small.’

Ashok Pathak came to the UK from India in 1978 and worked as an associate specialist in trauma and orthopaedics, serving the NHS for a total of 35 years and receiving an MBE for his contribution in 2010.


Ignored and abused

During his career, he encountered discrimination as a result of his ethnicity only twice, but says that both incidences came as profound shocks.

‘I remember the first occasion was while I was working as a junior in colorectal surgery back in about 1982 to 83,’ he says.

‘I walked in to meet a patient and the moment he saw me, he said that he didn’t want to be seen by me, and that he wanted to be treated by a white consultant.

‘I was totally shocked. I’d been in the country for around three or four years and had, to that point, never experienced anything like this.

‘At the time, the consultant supervising me was just outside the room listening to the conversation. He came in and immediately set the patient straight, and made it clear that I would be the one to treat him and no one else. That was very reassuring to know that, at that time, I had the support of my senior colleagues.

‘The other incident was around 1984-85; I walked past one of the porters in the hospital and said good morning to him. He totally ignored me so I went up to him to ask why. He said: “I don’t speak to Pakis.”’

Mr Pathak says that he reported the incident to the hospital manager which quickly led to the offending individual being suspended.

He adds, however, that the event, which had come out of the blue, had disturbed him, particularly because no one else had witnessed it or were able to back him up.

A greater proportion of doctors who qualified outside the EU – 41 per cent of those who expressed a view – reported encountering patients who did not wish to be treated by an overseas doctor, compared to 25 per cent of EU doctors having similar experiences.

Contributing to the BMA’s survey, a GP originally from India said it was common 30 to 40 years ago for patients to discriminate against those treating them and, although things had improved, there were new concerns for the future.

‘This was very common in the 80s. The attitude has changed for the better since then, but Brexit has brought the prejudice back. I am hoping it will be short-lived.’

Sharing their experience, one Nigerian-educated consultant says: ‘A patient stated that she “does not want to be treated by these foreigners”, that she wanted to be treated by those who know what they are doing.

‘I wasn’t offended because I know what I am doing and have always had excellent feedback from my patients. I felt she was just ignorant and exhibiting [an] ingrained culture.

‘The colour of the skin matters, unfortunately,’ says a graduate of an Indian medical school. ‘There is an inherent distrust that is present on first encounter which usually changes as the number of meetings increase.’


Brexit Britain

Mr Pathak said that while he felt society had generally become more open and tolerant over the course of his career, continuing pressures with the health service and political and social tensions stirred up by Brexit could jeopardise this.

He said: ‘My worry is that, with Brexit … frustration could boil up and non-white doctors might start to face a backlash from certain sections of society, although I hope I am wrong.

‘My advice [to doctors] is that if these situations occur, they should be calm, professional, not be abusive and try to reassure the patient. They should then go and report the matter straight away to their immediate superior and to their trust’s equality and diversity team.’

Since the UK’s vote to leave the EU, the BMA has called for the Government to guarantee the residency rights of the 135,000 EU nationals working in the NHS and social care system, as a matter of urgency.

The association has warned that failing to do so could precipitate a workforce crisis in an NHS already beset with huge financial challenges, poor morale and existing staff shortages.

In light of the latest survey findings, BMA council chair Mark Porter has urged health employers to ensure all international doctors facing discrimination from patients or colleagues received their full support.

He says: ‘Our health service is made up of thousands of dedicated and talented individuals, many of whom have come to this country from all over the world to offer their expertise and care to patients.

‘The next few years will see the country and the health service facing difficult challenges and uncertainties.

‘Service underfunding has brought the NHS to breaking point, made even worse by the failure of successive governments’ workforce strategies.

‘The rights of all international staff working in our health service must be prioritised in ministers’ negotiations with Europe, to safeguard against the hugely damaging impact that losing these individuals would have on the NHS’ ability to provide safe and effective care. The closely fought and frequently divisive nature of last year’s referendum worsened tensions around race, nationality and immigration status.

‘Employers have a duty to provide their full support to overseas doctors faced with verbal or physical abuse, and ensure that appropriate action is taken to tackle discrimination in our clinics and wards.’

What is discrimination?


Have you ever felt a patient didn’t want to be treated by you because you are an international doctor?

41 per cent of doctors who qualified outside the EU who expressed a preference said yes (compared to 25 per cent of non-UK doctors who qualified in the EU). Here is what some of them said:

Indian-qualified consultant: ‘A handful of patients have occasionally asked to see other doctors after they see me but before speaking to me; but once they actually have a consultation with me, they don’t want to see any other doctors in the team.’

Indian-qualified GP: ‘Yes but not often. Mostly people can recognise and appreciate a good doctor, whatever their country of origin, though they are less likely to tolerate any shortcomings.’

Indian-qualified SAS doctor: ‘One patient on my operating list clearly asked for an Englishman surgeon to operate on him. The saddest thing was that the trust did not clearly take a stand to not allow this on such a racist pretext and the matter got dispensed without specific recommendations to prevent similar recurrences.’


In your experience do patients treat international doctors differently to UK doctors?

49 per cent of doctors who qualified outside the EU who expressed a view said yes (compared to 38 per cent of non-UK doctors who qualified in the EU). Here is what some of them said:

Nigerian-qualified junior doctor: ‘Some of them [patients] are condescending, a few would take it as far as being verbally racist and ask for a substitute. It is much better than it used to be, we are told.’

Zimbabwean-qualified consultant: ‘Patients don’t trust doctors from abroad.’

Nigerian-qualified junior doctor: ‘While the majority of patients appreciate foreign doctors there are a minority who still believe race is the standard for judging performance. However, with the turn of events it may tilt this balance more towards discrimination.’

Indian-qualified consultant: ‘I think we have to work harder to get our patients to trust us. I think they are also much more likely to complain if they are not happy about something.’

Indian-qualified junior doctor: ‘Sometimes patients are eager to find out country of origin and then behave prejudiced. Overall a majority of patients don’t seem to be affected much where the doctor is from.’

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