The content of this website is intended for healthcare professionals only

Allowing patients to discriminate by race is ‘institutional racism’

Racists must be confronted not enabled, says medical director

Jo Carlowe

Wednesday, 05 February 2014

Allowing patients to choose the ethnicity of their doctor is institutional racism.

In a personal view published on bmj.com today, a medical director reflects on a case in which a hospital accepted the choice of the parents of a patient, who wanted only white doctors to treat their child.

Dr Nadeem Moghal, from George Eliot Hospital in Warwickshire, draws on the Macpherson report (the police investigation which took place following Stephen Laurence’s murder) defining institutional racism as “the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin”.

He says this report is “relevant to every organisation, private and public” yet this was not enough in a case which happened in a former workplace where parents of a child patient “refused to have care delivered by black or other minority ethnic doctors”. The clinical director at the hospital concluded that the parents’ choice “would be enabled”. The arrangement continued for more than a year.

However, following a difficult process the parents were told that “care would be provided by staff regardless of their ethnicity” and the family complied.

Dr Moghal asks what we can conclude from this case. He says that there are limits to patient choice and that “when racists are confronted they may ultimately relent”.

“Any organisation might find it hard to accept that it had behaved in an institutionally racist way but the Macpherson definition allows an understanding and creates an opportunity to strengthen the policies of public and private institutions, adding to diversity training, with the aim to make the enabling of racist choices a never event,” said Dr Moghal.

“This type of enabling has happened before, and will happen again unless leaders grasp the definition and provide the right narrative.”

Dr Moghal concluded: “The right outcome was eventually reached because of the courage and tenacity of those—including me—who stayed the course, but it was a difficult journey professionally and personally. I will always believe that what had gone on was a worthy subject for internal whistleblowing. The key lesson is that immediately confronting and standing up to racists rather than enabling them must be the first step to building equitable organisations.”

doi: http://dx.doi.org/10.1136/bmj.g265

Registered in England and Wales. Reg No. 2530185. c/o Wilmington plc, 5th Floor, 10 Whitechapel High Street, London E1 8QS. Reg No. 30158470