Dr Vinod Kakkar (name changed on request) had been practising in a North England hospital for three years, when a patient decided that she did not like his bedside manner. She filed a complaint against him with the hospital authorities, claiming that Dr Kakkar had been rude and unsympathetic towards her. The hospital authorities carried out an internal inquiry against Dr Kakkar and found that what the patient considered ‘rude’ was in fact simply a case of cross-cultural differences. The patient had misunderstood his demeanour and language because she was English and he was Indian. However, a few months later when a senior position fell vacant in the hospital, Dr Kakkar, who was the most eligible candidate for the promotion, was overlooked. Dr Kakkar’s experience is not unusual. Many doctors in the UK from ethnic minorities face similar problems daily.
The are 40,000 Indian-origin doctors currently practising with the British National Health Service (NHS). In fact, it is believed that if doctors from the Indian Subcontinent (India, Pakistan, Bangladesh and Sri Lanka) were to actually leave the UK, the NHS would collapse. Yet, even though they form the backbone of the country’s health system, it is found that Asian doctors are often bullied, harassed and discriminated against. A group called British Association of Physicians of Indian Origin (Bapio) has launched a novel scheme called Medical Defence Shield (MDS), which hopes to provide comprehensive support to doctors and dentists in difficulty. “Medical Defence Shield is an innovative and daring concept to ensure that doctors and dentists working in the NHS receive fair and just treatment,” says Dr Ramesh Mehta, president of Bapio.
The scheme provides both medical defence protection and support for employment issues under one umbrella. Doctors are able to pick and mix from a package of services traditionally offered separately by trade unions and medical defence organisations. “It is not an exaggeration to say that the traditional institutions have been known to drag their feet when it comes to supporting international medical graduates,” says Dr Satheesh Mathew, vice chairperson of Bapio.
Bapio claims it receives calls every week from doctors who say they do not get the support they need when facing allegations of malpractice during a disciplinary process. Examples of unfair treatment include cases where severe punishment has been meted out to doctors when all that was needed was training and support. The managers and supervisors who indulge in such unprofessional conduct virtually escape any reprimand, while ethnic-minority doctors are left with a blot on their careers. There are disproportionately higher numbers of ethnic-minority doctors reported to the General Medical Council (GMC) over their fitness to practise. Many of them have also faced disciplinary procedures for fairly minor issues.
“Patient care is paramount, but providing adequate and sensitive representation for doctors in difficulty is equally important. It is particularly unfair when an individual doctor is left feeling unsupported in the face of often unsubstantiated allegations of flawed practices in the disciplinary process,” says Dr Mathew, who has played a leading part in developing the scheme and is responsible for quality assurance.
Since its formation, migrant doctors have played a crucial role in sustaining services and development of the NHS. In the early 1950s, NHS employed a handful of overseas trained medical graduates. Most of them were the cream from Commonwealth countries of the Indian Subcontinent. They served in areas of Britain where Briton medical graduates were not willing to go. Over the past few decades, the number has soared. Currently it is estimated that the NHS has over 133,000 doctors, which includes 35,000 consultants and 35,000 general practitioners. Of these, 40,000 doctors and 15,000 dentists are of Indian origin.The total medical school intake in the UK of people of Indian origin is about 35 per cent. These figures do not include doctors or dentists from the rest of South Asia.
Even though Asians make up such a large proportion of the medical fraternity, Professor Liam Donaldson, chief medical officer of the NHS, last year, acknowledged, “Despite the existence of the Race Relation Act, many of our colleagues are enduring prejudice, unfairness and bullying, leading to a devastating impact on their morale and career.” Donaldson, originally from Gujarat, has lived in the UK for about 30 years.
Though there are bodies in place to supposedly help doctors with labour problems, they lack the cultural sensitivity needed. “Feedback from our members shows that the existing support system lacks empathy and understanding when it comes to issues of discrimination and unfair practices,” says Dr Mehta. “It is important to tackle discrimination and the potential for bullying at an early stage. The correct advice, support and intervention can make a lot of difference to the outcome of an individual case and prevent unnecessary psychological trauma,” he adds. His colleague Sanjiv Manjure, honorary secretary of Bapio, agrees and argues that the demand for support from its members has increased over the last few years. “There seems to be systemic failure on the part of institutions to seriously tackle unprofessional conduct of senior mangers,” says Manjure.
The MDS hopes to reverse this trend by providing Indian doctors with the support they need.
Launched in two stages, the MDS currently offers a competitively priced package of services providing advice and representation on issues like clinical and professional issues, legal representation during internal inquiries, and GMC and tribunal cases. The packages range from £250 to £560 for consultants and £200 to £273 for specialist trainees. The second stage will be launched in June. This will offer full professional indemnity cover and financial compensation for patient incidents not covered by standard NHS indemnity. Aimed at consultants in private practice, this service is likely to be one-third cheaper than existing medical defence covers. Claims here will be dealt with by doctors with a legal background.
Though begun by Bapio, the MDS is available to all doctors working in the UK, not just those from ethnic minorities because they have realised that all doctors need this extra support. A dedicated 24-hour helpline manned by experienced medical advisors will be the first port of call for any doctor in distress. The non-profit MDS will aim to help alleviate the pain felt by doctors in difficulty, and with empathy.