I’m a racist.
I am. I judge people on their ethnic background. That’s a reality of my job. People with different ethnic backgrounds have different conditions. That’s what pathology is. I’ve never seen a white man with Sickle Cell Disease.
Racism is defined by the OED as:
‘the belief that all members of each race possess characteristics, abilities, or qualities specific to that race, especially so as to distinguish it as inferior or superior to another race or races‘
Alright, I’d like to think that the second bit doesn’t apply to me (and here I suppose I must Check My Privilege) but the first bit does. I make judgements and risk-stratify patients according to their background. I was taught this at medical school,
Consider some exam questions-
‘A twenty year old Irish lady presents with abdominal pa…’ the question would lead… We would think of-Coeliac disease! She’s Irish!
‘A thirty-five year old Pakistani man with cough and fever…’ – in an exam context this is TB until proven otherwise
Back in the nineties when I was at medical school, country of origin in exam questions was also used in HIV patient descriptions, reflecting the distribution of the virus at the time.
These snap thought processes we make are well intentioned, however else (judgemental) they may appear. They are often what raises your suspicion of a certain condition in one patient as opposed to the different-background chap with the same symptoms in the bed next door. I judge on sexual orientation, job, whom someone lives with…. All are clues, all are little pieces that build together the jigsaw of diagnosis.
Suffice to say I’ve never sent my SHO to break into someone’s home like Gregory House does, but I reckon I could make some sharper diagnoses if I did. Maybe one day.
Here’s an unusual one. Black men can have different patterns on their ECG to white men. One of these days someone will overhear me looking at their tracing and saying, ‘Is he black? Oh, I wouldn’t worry about it then’ and there’s going to be a lot of explaining to do.
The word racism is, as the OED suggests, heavily steeped in the concept of one race superior to another. This is clearly rubbish, yet depressingly a commonly held belief. We must be sensitive to the background of our own thoughts with which we approach people. Where did you learn each fact about disease prevalence, why do you think such-and-such diagnosis more likely? I wouldn’t think any less of you if you had TB or HIV or late-onset diabetes. And I would not think less of you if your ethnic background were different to mine.
I was shocked at work once (all tales are non-contemporaneous) when a senior nurse, having recently moved from London, quite unprompted and on the first time we met, remarked that it was ‘nice to be in an area with white faces.’ It was like that Kevin Eldon scene in I’m Alan Partridge.
I was blown away, taken aback. Not simply by what she had said but the fact she had said it at all. I *must* have misheard, surely?
I like to think that I might have raised my voice and asked her to repeat it to clarify. But I didn’t. Confused and disorientated (reeling as I questioned what I must have misheard) I just grunted and changed the subject. Her comment was effectively endorsed by my omission.
NHS trusts work in a zero-tolerance basis. It was my duty to pick her up on it, but I failed as I was too embarrassed to clarify what I had heard and deal with it. Complete fail. Here was I, who judges others, unable to ask for more evidence for something that really mattered.
Better check that privilege again.
idratherbeinresus 