In a personal view published on bmj.com today, a medical director in the United Kingdom 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 organization to provide an appropriate and professional service to people because of their color, culture, or ethnic origin."
He says this report is "relevant to every organization, 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."
He says that any organization may find it "hard to accept" that it had behaved in an institutionally racist way but that Macpherson's definition allows understanding and the strengthening of institutions' policies.
Dr Moghal concludes that although it was a difficult journey, the "right outcome was eventually reached" and that the key lesson is "immediately confronting and standing up to racists."
- N. Moghal. Allowing patients to choose the ethnicity of attending doctors is institutional racism. BMJ, 2014; 348 (feb04 6): g265 DOI: 10.1136/bmj.g265
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