Race Relations

One of my mid-morning tasks is to read the day's correspondence. Hospital letters are usually rather dry, informative missives and I scanned such a pile this morning. There was one, however, that stood out. It was from the Surgical department at the infirmary. I had referred a lady on a matter that was beyond my expertise (assuming of course, I have any in the first place!) The typed summary commenced in the usual polite fashion and proceeded to give details of a thorough examination, appending the results of relevant and sophisticated investigations.

The closing paragraph caused me to almost cough my coffee over the page. The doctor wrote that my patient, Mrs Predd (Judith) commented disparagingly about the colour of his skin and enquired whether he might not be better practising in the land of his origin. She had apparently proceeded to denigrate his senior colleague, of similar ethnicity whom, he said, he was relieved was out of earshot. Despite the unsolicited and unwelcome comments, he agreed to review our patient again on clinical grounds, but stated that if she were to vent forth again in such an inappropriate fashion there would be no option other than to “suggest she seeks her future care elsewhere.”

I was astonished. Firstly, that this seemingly rational patient should own such opinions and, secondly, after receiving excellent care and attention should feel it necessary to express her beliefs in such an intemperate and inappropriate fashion. I was also annoyed and embarrassed. I wondered whether I should call my hospital colleague to thank him for his tolerance and apologise on her behalf but she really only represented herself, not the practice. If I were to contact him, it would be to say that I had not been aware of her overt racial prejudices. I would be happy to share in any decision as to how best deal with the matter.

This was of course not the first time I have encountered prejudice, racial or otherwise, in my career. My observation is that prejudice rarely comes from those who have contributed much to society themselves. I sometimes listen to patients describe their frustration at finding the doctor in clinic as having been difficult to understand. This may be an actual problem but a melodramatic, lampooning of a thick Pakistani, East European or Oriental accent is unnecessary and really rather foolish. Imitation is not always the sincerest form of flattery.

People seem to forget that Asian, African and other doctors, born or trained abroad, have much to offer the NHS. Indeed, they are often better educated and more competent than their “home grown” counterparts. It may be the glittering prize for graduates from India, Malaysia or Kenya to work in the UK and this is only achieved by passing additional entrance exams, including demonstration of competence in written and spoken English. How disappointing it must be for these doctors to discover a lack of appreciation and even hostility from their patients; the very people to whom they offer their expertise and knowledge.

It should not be forgotten that doctors from abroad were invited to work here during the 1960s when medical staffing was in crisis. The then Health minister, one Enoch Powell interestingly, anticipated a critical shortage of medical personnel and made an urgent appeal for doctors from abroad. Some 18,000 Asian doctors answered his call and soon filling these vacant positions. Many of the GP posts were considered less attractive or less prestigious, mainly ones in inner cities or industrial urban areas. In secondary care, specialist Asian doctors could often only gain access to the more “Cinderella” specialities. One such doctor later said that: “If a job came up the English person would get it first, followed by the Scot, the Welshman, the Irish, the Pakistani, the Indian, the Sri Lankan, the West Indian and the African. This was regardless of qualification-but it meant I knew I would get the fifth job to come up.” (And to think I would have taken umbrage at being placed second!) Fortunately, such a pecking order now longer exists, at least not at an institutional level.

I am no more in favour though of so-called positive discrimination where minorities are given preference in order to achieve “balance.” This may be well-meaning but again fails to recognise true merit and suitability for a job.

As this generation of Asian doctors approaches retirement, it is predicted that a further import of doctors from abroad may be required. At present a quarter of all UK medical personnel are from the Indian subcontinent and this may rise. If they are of the calibre and have the dedication of their predecessors they should be welcomed with open arms.

Mrs Predd (Judith's) arms, however, will likely be no more open than her mind. After consideration and discussion with colleagues I sent her a letter. I suggested she might wish to clarify why she replaced the more customary words of thanks with hurtful ones.

I expressed my disappointment that she had chosen to embarrass herself, her GP and the hospital doctor.

I doubt my carefully chosen words achieved much and she probably continues to spread her own thoughtless ones. I suspect I'll never know, for she failed to reply, such was the strength of her argument.

Dr Ken B Moody