The past few weeks have exposed the bitter and entrenched racial divides that continue to persist in western societies. None more so than in the United States, which with its unique history of industrial-scale enslavement and segregation laws seems to be battling with a more visceral manifestation of racism than any other developed country in the world. The majority of people are not overtly racist. Yet outlawing the Ku Klux Klan and not using the n-word are simply the tip of a vast pyramid of covert and institutionalised racism which frustrates the lives of black and ethnic minority people on a daily basis. The medical field, for all its virtuous ideals, is not immune from this.
Using myself as one small insignificant example. As a black surgeon I’ve lost count of the number of times I’ve been stopped in a hospital corridor by nurses or other doctors and asked to take a patient to the x-ray department. The assumption being that I must be a porter. The apologies and embarrassed expressions on people’s faces when I correct them highlights the fact that these people aren’t actively racist, they’re just steeped in unconscious bias. At the lower end of the scale this leads to pleasant misunderstandings, but at the more extreme end it leads to black men being perceived as ‘dangerous’, resulting in frightened women needlessly calling 911 and prompting a more aggressive and at times deadly response from police when they show up.
Black and minority doctors (foreign graduates in particular) may find themselves excluded from the alcohol-centred after-work social circles for any number of cultural or religious reasons. These networking opportunities grease the pathway of career progression for many and help with the formation alliances that can be called upon for support in the midst of legal difficulties or disciplinary proceedings. Minority doctors are more likely to find themselves hauled in front of professional misconduct panels and receive harsher penalties than those of their white counterparts.
The Eastern Association for the Surgery of Trauma (EAST) led the way last year through its new Equity, Quality, and Inclusion Task Force. Under the banner of #EAST4ALL they aimed to highlight and tackle the difficulties faced by surgeons as a result of unconscious bias against their race, gender, religion, sexuality and country of origin among other things. In recent weeks the AAST has reaffirmed its commitment to fighting all forms of discrimination.
We know that racial bias can affect the quality of communication and patient-centred care delivered. Specifically, in trauma, minority patients have been shown to cluster at trauma centres with worse than expected mortality outcomes. Other studies have highlighted the perception of pain thresholds in black patients to be higher than those of white patients leading to patients’ analgesic requirements going ignored and perhaps even playing a part in the higher rate of maternal deaths among black women.
More and more institutions are offering resources to empower white staff members to become allies of their minority colleagues. Departmental leads must commit to cultural shifts and the enforcement of departmental policies that deal with discrimination and bias expressed by patients as well as colleagues. Diversity and inclusiveness within organisations leads to new creative ways of thinking and the development of novel solutions for old problems. We must all be made to feel comfortable and worthy of our seat at the table.
Obi Nnajiuba is a British surgical resident with specialist interests in trauma, acute care, prehospital care, triage, mass casualty events and trauma systems. His postgraduate qualifications include an MSc in Trauma Sciences and membership of the Royal College of Surgeons of England. He is also a registered Motorsport UK physician, providing trackside advanced trauma care to competitors at world famous motor-racing circuits such as Brands Hatch, Goodwood and Silverstone.
