The dilemma

A fourth year medical student contacted the MDU’s advice line about an incident that occurred on a surgical ward round. The consultant had asked a pre-operative patient in their forties if they would mind the three medical students examining them as it would be a good learning experience. The patient readily agreed and the doctors moved on with the ward round while the students stayed to perform the examination.

The first two students examined the patient and left but before the member could follow suit the patient told him that he would not let him examine him, using a racial slur by way of explanation. The student did not reply but simply left the cubicle to rejoin the ward round and did not mention the incident to anyone as he was too shocked at the time. Discussing the incident with friends, the student decided he wanted to address the matter but was unsure if there were ethical issues in doing so.

Racism under the spotlight

A recent investigation by ITV revealed the number of racist attacks against staff in the NHS rose from 589 in 2013 to 1,448 in 2018 so our member’s experience was sadly not a rare occurrence. In response to concerns about racism in the NHS, England’s health and social care secretary, Matt Hancock, wrote a letter to all NHS staff and specifically acknowledged the account of Mr Radhakrishna Shanbhag, an orthopaedic surgeon, who relayed his experiences of racism in the NHS.

The letter penned in November 2019 stated:

“If you face abuse, do not accept it. If you see a colleague being abused, do not ignore it. If you know of an employee facing this, do not stand for it. The government takes a zero tolerance policy approach to dealing with racist abuse whenever it arises. Things should be no different in our NHS.”

It went on to confirm NHS Trusts should ensure staff knew they would be supported by senior management if they faced racial abuse.

The NHS has had a zero tolerance campaign in place against violence and intimidation of staff since October 1999 and patients are often aware of this policy due to notices within hospitals and GP premises or on websites.

What you can do

Racism is not something healthcare staff should have to tolerate and there are various options for addressing it when it arises. As a medical student, if you are the victim of racism from a patient, there are several things to do:

• Firstly, it can help to make a draft statement of what was said or done to you with verbatim quotes if possible so that there is a contemporaneous record of the incident.
• If other people were present and witnessed the incident, then you should make a note of their name and job title so they can be asked for statements during any subsequent investigation.
• Report the behaviour to your supervising consultant so it can be investigated and dealt with by senior medical staff and management.
• Racist comments may not come from an apparently calm patient as an isolated insult as in our case above. Instead, it can rear its head in the context of an already angry patient who is complaining about other aspects of care. If the patient shows signs of agitation or anger it is important to protect yourself.
• Depending on the nature of the incident some patients may get a verbal warning. However others may be required to sign a behaviour contract or receive a formal warning letter. An example of this in action can be seen in North Bristol Trust’s “Red Card to Racism” campaign. This means patients abusing staff will be challenged and warned, leading to a ‘yellow card’. If the behaviour is repeated they then receive a final red card in which treatment would be withdrawn as soon as is safe to do so.
• In some cases, racist abuse of staff may require police involvement.

MDU advice

The MDU adviser assured the medical student that regardless of the patient student dynamic, it would absolutely not prevent him from reporting his experience of racism. Patients cannot rely on the doctor or student patient relationship to shield them should they racially abuse NHS staff or students.

In the first instance, the student was advised to raise the incident with his supervising consultant so that they could support the member and discuss with senior colleagues and management how to tackle the issue. The student called back a few days later to confirm that the patient had been given a written warning about the incident.