Communication breakdown: Dealing with racism (2024)

Dr Sonali Dutta-Knight and Dr Ed Pooley look at how GPs can address racist patients – both as a minority ethnic doctor and as an ally

Racist comments, either overt or more subtle, are sadly a common occurrence for minority ethnic GPs. Although these GPs could hardly be blamed for taking a harder line with such patients, sadly many GPs have had to become skilled in defusing such situations, and continue to provide the highest standards of care.In this article, we look at ways of dealing with such comments that you may or may not have thought of.

However, this is not a battle that minority ethnic GPs should have to fight alone. So we consider what all GPs should do to become allies when it comes to such comments.

‘How do I tackle racist comments towards me from patients? I often struggle to know what to do at the moment.’

The bar for labelling racism continues to be set as overt actions such as violent behaviour and name-calling. These are the forms of racism that are easy to spot and address, as we witnessed in this summer’s riots. The type of racism that GPs encounter most frequently however, is covert and insidious: the ‘microaggression.’

Dealing with overt racism and escalation

Overt racism, while easier to identify, document, and address through practice policies, can be distressing and challenging in real-time situations. It is more likely to occur when dealing with an already angry patient. If abuse cannot be de-escalated, GPs should consider:

  • Terminating the consultation;
  • Using the panic button if the patient becomes violent;
  • Making a note of the offensive language;
  • Bringing the issue to the practice manager to deal with the behaviour appropriately, potentially involving written or verbal warning;
  • Do not feel pressured to continue treatment unless it is a true emergency.

The NHS has a zero-tolerance policy against all forms of violence and intimidation of staff. Notices should already be displayed within GP premises and on websites. Additionally, practices could consider allyship training, as not everyone fully understands what this means and entails.

Dealing with microaggressions

Microaggressions are defined as behaviours or comments that convey bias against historically marginalised groups. They aim to stereotype and demean and are often disguised as casual remarks, making them easy to overlook, or give the perpetrator plausible deniability when confronted.

Common examples in healthcare include: ‘Where are you really from?’; ‘You speak very good English,’; or a patient insisting on seeing a white colleague. These interactions disrupt the flow of a consultation, are irrelevant, and are immediately recognised by the recipient as harmful.

Microaggressions, whether intentional or unintentional, result from unconscious bias. When called out, they are frequently defended with responses like ‘It’s your fault you took it the wrong way.’

Understandably, many healthcare professionals of colour opt to choose their battles wisely and don’t confront microaggressions to avoid unnecessary conflict or complaints.

However, addressing microaggressions, even in a gentle manner, is important for fostering change. Responses like ‘Why do you ask that?’ or ‘What makes you say that?’ can defuse the situation, highlighting the microaggression without escalating the conflict, and allow the consultation to refocus on the patient’s needs.

‘How do I support my colleagues when they face racism from patients?’

Be anti-racist

It’s not enough for colleagues to simply identify as ‘not racist.’ In a society where extreme racist violence has become more visible, being actively anti-racist is essential. Gaslighting colleagues is unacceptable – allyship involves showing respect and empathy. Also, white allies, particularly those respected in the community, can inspire change through their actions:

  • Start conversations: Don’t avoid discussions about racism. Engage with colleagues about their experiences and listen actively to understand their perspectives.
  • Believe and support: Recognise that just because you don’t experience racism doesn’t mean it doesn’t exist. Avoid dismissing or invalidating others’ experiences. Understand that a patient who is kind to you might still be racist towards others.
  • Educate yourself: Take responsibility for learning about racism and privilege. A wide range of resources is available online and in literature. Don’t rely on people of colour to educate you; this responsibility is yours.
  • Recognise privilege: Having privilege doesn’t mean your life hasn’t been difficult, but it does mean there are challenges you won’t have to face. Recognising this can help you empathise better with others.
  • Accept mistakes: Mistakes are inevitable. What matters is acknowledging them, apologising sincerely, and learning from them.

Being anti-racist is an active, ongoing process that requires commitment, self-reflection, and action. By challenging biases and supporting colleagues, healthcare professionals can help create a more inclusive environment for everyone.

As doctors, our natural instinct is obviously to alleviate the suffering of our patients. But, when a patient is racist and makes discriminatory comments towards our colleagues, it is difficult to know how to address the situation and our duty of care. Sadly, specific guidance is fairly difficult to find, and what is available feels inadequate. For example, a 2016 article by Whitgob and colleagues suggested a four-step approach for physicians confronted with a patients’ racism: 1) ignore such comments in an emergency; 2) focus the encounter on the shared goals of treatment; 3) depersonalise the event; and 4) foster a community of support within the hospital.

Even as a person unlikely to be on the receiving end of such behaviour, the above approach feels too little and invalidating to the doctors who experience this type of discrimination. For white GPs, contact with racism comes either directly through patients making comments to us about other members of staff; or through trying to support colleagues who have received racist comments from patients.

In this type of conflict, the doctor is often in the invidious position of having to balance several priorities. There is the need to provide care for the patient; wanting to protect our colleague who has been the subject of the racist comment; and trying to set aside our feelings about the comment so that we don’t prejudice our care of the patient.

One approach that can be used is the following sequence of phrases-selected on assessment of the situation (from least to most directly challenging):

  1. I’m not sure of the relevance of that comment… Can you explain?
  2. I feel uncomfortable with that word, (or phrase, statement, etc.). Let’s focus on…
  3. I don’t accept the use of that term-let’s move onto the issue regarding your…
  4. That type of statement/phrase/comment is not acceptable here, regardless of your reasons. We have a zero tolerance policy at this practice/hospital/company.

Challenging inappropriate behaviour is one of the biggest challenges we face in medicine. But it is one of the most important and crucial actions we must undertake if we are to change attitudes and support our colleagues. Obviously, if you’re an employer, you also have a legal responsibility to protect your staff, but all those in the practice have a responsibility towards our colleagues.

Supporting colleagues: bystander and allyship

Likewise, if you are a bystander and this is happening to a colleague – you can use this approach to speak up on their behalf. As allies, we need to be active in promoting an anti-discriminatory approach.

The stepwise method above offers two benefits: It is easy to start at statement one without feeling too uncomfortable as the onus is on the person making the comment do the work (the implication being that they recognise their behaviour is inappropriate); and you are attempting to move the conversation forward and providing a boundary if required (step 4, which may progress to removing the patient from the interaction).

If this happens to a colleague, be supportive. Don’t discount or normalise. Saying or doing nothing can be seen by the patient as tacit support for their viewpoint. It might also make the next interaction more difficult as the patient may continue to be discriminatory under the belief that this is acceptable to you.

Having visible signs in your practice can reinforce this approach; discrimination based on ethnicity is not ok or acceptable, since zero tolerance is often framed or understood by patients in the context of violence and aggression only. For example: ‘Things that are considered inappropriate’ by this organisation – and having a list of scenarios. By encouraging the conversation, we can encourage change.

Dr Sonali Dutta-Knight isa GP in Newcastle and founder and lead administrator for Healthcare Professionals Against Racism

Dr Ed Pooley is a GP with expertise in time management, patient communication, and managing ‘difficult conversations’. He is the author of Managing Time in Medicine:Developing Efficient Consulting in Primary Care

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Communication breakdown: Dealing with racism (1)

Communication breakdown: Dealing with racism (2024)
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