THE ELEPHANT IN THE ROOM:
the Life and Times of a BME Doctor in the NHS - from Recruitment to
Embitterment
Suresh Rao
These are my
personal observations and experience of working for thirty five years in countries of three
continents (India, Canada and UK). Till I became the President of
the Indian Orthopedic Society of UK (IOS-UK) around 2005 I had no reason to acknowledge the
existence of discrimination in the NHS. I had passed all my examinations at the
first attempt, I had become a consultant in the early 1990s at the same average
age (about 37 years) of any UK born white male doctor in orthopaedics at
that time. It was only after I had blown the whistle while actually observing
the horrendous treatment meted out to my colleague orthopaedic surgeons did I
actually personally experience racial discrimination in the NHS in its ugliest
form.
I have now come
to recognize that the traditional attitude to recruiting and retaining BME
doctors and nurses into the NHS is no different from the ‘Discard After Single
Use Only’ policy of the slave trade. There is little security or safety and no
fairness of treatment. The system of incentives and reward for hard work and
competence simply do not seem to apply to BME staff. Unlike others, the course
of life of a BME professional whether doctor or nurse seems to follow several
distinct stages.
1. Stage of
Denial: We work hard to keep the home and family together, crediting our
limited successes to the support of others. Any perceived failures are almost
always attributed to bad luck, never to the possibility of discrimination.
2. Stage of
Panic: Naively believing that blowing the whistle is good for the sake of our
patients, we publicly voice our concerns forgetting that those responsible for
the cock-ups in the establishment will not thank a BME for exposing their
incompetence. Such persons will not hesitate in recruiting others even less
scrupulous than themselves to intimidate and harass you for the loss of their
‘private empire’ style of working. They usually have no difficulty colluding
with your colleagues who are probably already dreading the loss of their
private practice to others. The establishment leviathan is now ready to turn
against you for stirring up a hornet’s nest when you were least expecting this
response.
3. Stage of
silence: We are made to feel guilty for creating a conflict in the
department where none had supposedly existed previously. We become vulnerable
to subtle emotional blackmail by promising to avoid future conflicts and
agreeing to behave in a more ‘civil manner’, i.e. accept that we should next
time bring up any issues ‘face to face’ for a ‘negotiated’ resolution of
‘confusions and misunderstandings’ rather than going through the employer. We
are later reminded of this sword of Damocles hanging on our heads and we become
too frightened to think rationally, instead we too begin to behave like any
victim would. We invite others to quash us underfoot like a worm by tacitly
acquiescing to the rules of their game. This not only bolsters the opposition but
also puts our relationship with our employer in jeopardy. We now enter a state
of limbo in our career progression to the extent of even questioning our own
achievements and wondering whether we had truly deserved our CEA points, if we
managed to get any. We convince ourselves that this was just a favour granted
to us by our generous employer but only with the benevolent support of our
well-meaning colleagues. We begin to lose our self-esteem and any frame of
reference we may have for our sense of self-identity, our moral character is
disabled and allows us to do peculiar things we would never normally do. We are
soon at risk of losing our raison d’être.
4. Stage of
Escalation: Unfortunately a number of us cannot or will not read the writing on
the wall. We may injudiciously allow the situation to escalate out of control
and pave the way leading to our own harassment and intimidation at the hands of
the abusers in the establishment. If this does not succeed to cow us down we
are then threatened with disciplinary action including the possibility of
instant dismissal for supposedly ‘serious charges’ including criminal
prosecutions for what are really minor infractions. The establishment will not
hesitate to dispense summary retribution through Dismissal Orders under ‘MHPS’
for trumped-up charges and enforce redundancy despite any findings of the Employment Tribunals. It is not uncommon
for us to be referred to the GMC by this stage as the latter is hand in glove
with the Medical Directors against the BME and feels obliged to take up
investigating all such matters despite no evidence being submitted by the
Establishment, a clear case of disproportionately handing out injustices to
BME.
5. Stage of
‘Resolution of Conflagration’: this usually means a ‘negotiated settlement for
enforced retirement’ and it is most diabolical that this sometimes comes about
because the innocent BME cannot bear the humiliation of a criminal trial or a
GMC hearing and will most likely be on the verge of deciding to commit suicide.
Suggestions to avoid such a fate:
This is
difficult because everyone reacts to crises in completely different and
unpredictable ways. Following is just commonsense, not rocket-science:
1. Maintain good medical practice (and
relations with colleagues)
2. Know the law (including the latest
version of MHPS and PIDA)
3. Take advice from a mentor (and follow
every step correctly)
4. Anticipate trouble (band up together,
join BAPIO and MDS)
5. Use local procedures fully (keep
meticulous documentation)
6. Involve regulatory bodies at an early
stage (NCAS, GMC, CQC, CPS)
7. Remain vigilant and focused, be
discreet, stay calm and never say die
The elephant in
the room is discrimination, name it, call it out, learn to effectively deal
with it and work to reduce its harmful effects on yourself and others.
Prof Suresh Rao
Consultant
Orthopaedic & Trauma Surgeon
North Cumbria
University Hospitals NHS Trust
Hon. Professor,
University of Cumbria
(The above is from the talk given by Suresh Rao at a meeting in Manchester on 26 March 2013. All the content are the personal views of Suresh Rao)
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