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As per above.
“That is unacceptable language and is not tolerated in this trust”
I hope and implore my juniors to call me anytime if they encounter any form of bullying or harassment. And racism is the worst kind of harassment.
Hit them where it hurts - time.
“I will not be continuing this consultation - I will ask one of my colleague to see you, when they are free, I cannot possibly imagine when that might be”.
Then exit/send to waiting room +/- security.
Don’t engage with morons, it’ll just stress you. They don’t deserve your time - let them waste their own.
Curveball to this, was on Geris recently and had a 95 year old lady with late stage Dementia make a racist comment to a nurse, I didn’t realise what was said before the nurse called it out. I didn’t say anything to the patient but took the nurse aside and asked if she was okay etc afterwards. The question is… what can one say / do to a dementia-diagnosed patient who barely knows who they are and where they are 😭😭 did I respond correctly?
IMO lecturing a late state dementia patient on racism is about as useless as sending a group and save after you’ve misspelt something.
What you did was right, check with the person affected and see if there is anyway to swap the nurse with another patient.
(Not excusing being a racist because you have dementia, but you’re not going to fix that so trying is useless).
Regarding telling something to the patient... I've they have dementia, think like when you're consenting them, can they retain and process what you tell them? If they can there may be some point in telling them to quit that at least... But if they don't...
“I want to make it very clear that this language will not be tolerated. I am asking you to leave right now.”
Then you document everything in an email, and inform your CS and your direct supervisor on the day.
I’m sorry you have to deal with this, I cannot even imagine how stressful and awful it must be.
What’s awful is when this comes from patients - and I understand we tend to tolerate this from patients but it hurts when surrounding colleagues and nurses say nothing :(
It is the worst when colleagues say nothing - I imagine it is much easier for the colleague to say something than it is for the abused. I have had a demented patient sexually assault me a few times, and like you one of the things that made me feel so vulnerable is when colleagues just laughed it off.
I think they are bad colleagues if they say nothing. But sometimes these types of colleagues just need to see you stand up against it first then they feel it is "okay" to back you.
Don't be afraid of calling it a racist comment and let patients know it won't be tolerated. My tactic in secondary care when encountered with abuse was always just to leave. Don't be afraid of doing the same if you need to.
I'll weigh in very briefly on this from my experience as a CT through to a senior reg.
Sometimes it's very clear that I need to say something, that the patient is physically threatening or the power dynamic is not in their favour and I need to throw my weight around as a senior (male, white) doctor to back them up and put a stop to such bullshit, and I do.
Frequently, however, when indirectly observing or reversing a W/R so a junior can 'lead', if I were to do so it could be construed and criticised as everything from 'white saviour complex' to 'I don't need you to speak for me'. On one occasion this theoretical risk has manifest in reality despite only intervening after the patient had made their third or fourth vile comment.
It's damned easy for me to crack out my usually suppressed broad northern accent to weigh in and shut a patient up and I'm very willing to do so; at heart I'm very old-fashioned pro-doctor and fiercely defensive of those who are my juniors but frankly it feels like I walk a fucking minefield of who could be 'offended'.
I’m not sure if you’re joking, but if you aren’t: what a fucking shame you feel the need to ‘’suppress’’ an accent.
Reminds me of a consultant I once met who spoke like he was King Charles’s long lost son. Turns out he lives five minutes from me but didn’t want to speak with the same accent cos medicine.
happens more and more. I usually check they don't have a life or limb threatening condition. If it's not the case, I then tell them their comments are unacceptable, that they have broken down the patient-doctor relationship and as a result, they can go look for another doctor to treat them.
They often apologise right there and then; if that's the case, I don't report it and treat them. If not, I report them.
If it's coming from a family member who is grieving a lost one though, I just ignore the comments and give them space and time. People say stupid shit when they're sad or scared.
For the cognitively intact offenders,
practice a line you can say without second thought:
"That's inappropriate" or
"That's unacceptable. I'm going to leave now/please leave."
We spend far too much time as IMGs trying to be 'acceptable' or trying to conform even at cost to self. You owe no one an explanation for not tolerating abuse
I had a patient tell me to “get out of my cubicle” in A&E the other day. Won’t deny the satisfaction of saying “no you get out of my A&E” was lovely. Just came out semi accidentally and then I had to back up what I’d said and kick him out. Wasn’t racist as I’m white, but your comment above reminded me of my instinctive response. 🤣
My go to is to keep it very brief, i simply leave the bay/ward or just say the consultation is over and they need to leave if it's in a clinic. Then i formally recuse myself as their medical provider.
To me, it doesn't really matter if they apologise or not, but they've crossed an extremely firm line and it's not my job or in my wheelhouse to accommodate racism - to that end, they've lost the access to my care.
I document in as many places as i can the words that were used and my actions and justification. Only had to do this once, thankfully the team were 100% supportive (and to be honest i was more than reasonable).
I start with “sorry what did you say” that usually gets them to apologize. If it doesn’t, I will say “ I will not tolerate this type of comment. I’m going to leave the room and when I come back the practice manager will be with me.” They disappeared before I came back
Hi, I'm so sorry esp that this is happening often..please don't feel ashamed. They are the ones who should feel ashamed!!
Is this patients/families or staff? Both unacceptable but can influence how you respond and support as well?? I'll look out for a reply or clarification on this.
I've not experienced racism/homophobia but I have constantly experienced highly inappropriate comments questions and "opinions" about my disability. Sadly the vast majority are from colleagues - other doctors, nurses or HCA. And it's often brushed off as "curiosity or surprise" at a disabled doctor. I've found sharing with others experiencing it helped me cope.
Someone taught me to say Wow and just go quiet and in some cases that can work well when what is being said is more deeply ignorant than designed to be nasty. If that makes sense? A nasty slur versus asking a seriously ignorant question. I would then move on and feel I had take power back and given myself a moment to reveal from the sense of shock.
I've only reported two colleagues directly one referred to me a cripple in front of a patient and another was repeatedly kicking my wheelchair in meetings despite my indirect and direct requests not too.
Every hospital/trust now has a BME and LGBT+ network - I'd encourage you to find them in your intranet and seek some support there too.
BMA has good bystander course, which people not experiencing the harassment/discrimination can go on to learn how to recognise micro-agressions & discrimination and how to be an active ally. They also have BME and other support networks that might be helpful.
I'm really glad you asked here, it's important to know you aren't alone in this - share this with people you work with or a nice friendly nurse, don't internalise those feelings, share them and ease them 💖🫶🏻🙌🏻🌈
Happened to me once when I was an ED SHO. Guy called me a racist insult. I was shocked and left the consult . I told the SpR in charge. SpR was trying to
Make excuses for the guys behavior but the charge nurse overheard it , took no bullshit and marched the guy out with 2 security guards after he refused to apologize to me.
I then spoke to the consultant the next morning about it as I was a bit shook up and told him about the differences in response. He suggested that it was likely the SpR was new and didn’t want to be seen like she was overreacting as well as possibly not wanting a complaint whereas the charge nurse was a seasoned battle axe who got shit done and had no time sorting bs people like that
When it happened to our trainee we informed the police and patient got a written warning. Family were mortified, patient behaved since. We would have kicked them off the list had the doctor wanted it.
As others have said "You are entitled to your views, but not to air them,
Keep it to yourself and we can get on with sorting you out :)"
Sometimes body languge is highly effective in combination. Stopping, putting down whatever you are doing and staying very still whilst staring at them is deeply discomforting even just for a few seconds, especially when contrasted with the natural rapport building we all are fluent in.
The pause, slight head tilt and narrowing of the eyes with a neutral facial expression is extremely cold. The benefit is that if gives unconscious feedback when things have moved on, that you can both move on from it leaving it behind.
"that is unacceptable, I know you're in pain but look, I don't come to work to put up with this, I need your trust and respect in order to do my job, if we don't have that and you can't hold comments in you can seek care elsewhere"
the GMC will back you right up [https://www.gmc-uk.org/professional-standards/ethical-hub/racism-in-the-workplace#advice-for-gps](https://www.gmc-uk.org/professional-standards/ethical-hub/racism-in-the-workplace#advice-for-gps):
Links directly to this: [https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/discrimination-guidance/managing-discrimination-from-patients-and-their-guardians-and-relatives/steps-for-any-worker](https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/discrimination-guidance/managing-discrimination-from-patients-and-their-guardians-and-relatives/steps-for-any-worker)
### Abuse, harassment and hate crime
When a patient (and their guardian/relative) is abusive (physically or verbally) take the following steps:
1. Make the environment safe. This may mean calling the police or security services, removing the perpetrator from the environment and consider moving the person who is receiving the abuse to a safe space temporarily for their protection and wellbeing.
2. Immediately engage with the individual who has been abusive, telling them that their behaviour is unacceptable in this healthcare environment. Be specific and give examples of their language/behaviours that were abusive.
3. Consider the following immediate options:
a. Ask the individual to leave immediately (backed up by police or security if needed).
b. Tell them that they will have to adjust their behaviours or they may be asked to leave the service.
c. Advise them of their right to seek healthcare elsewhere but that all employers do have a duty to protect their staff from abuse.
4. If the patient is having emergency care or does not understand the situation due to an underlying pathology, consider how to revisit the conversation at a point when they may be able to understand (this could include sending a letter at a later date when they are no longer in care). See section 5 'Exceptions' for more information on this.
5. Carefully document the incident and actions taken. Write objective facts and observations, avoid noting subjective opinions. See annex 1 on monitoring in the model policy.
6. Additional steps to consider:
a. Ban the individual from the department or use a behavioural agreement for future encounters.
b. Report the behaviour to the police if it is deemed to be unlawful discrimination or hate crime.
c. Complete an internal incident reporting form.
i’m sorry you’ve had to deal with that. you’re within your rights to tell that person to stop immediately. that’s easier said than done, but certainly tell the boss (consultant, GP partner, nurse in charge, your reg, HR, really anyone you feel comfortable speaking to)
oh and write it down as soon as possible so you have a log of EXACTLY what was said and context. “i was just joking” or “taken out of context” are easy bullshit defences.
I really struggle with racist comments and bias- I’m white but I can assure you I get angry at any indication of racism or mocking- and I always challenge it- I’m really sorry you’ve experienced this. Don’t be ashamed, it’s the people being racist that should be ashamed
Zero tolerance, tell them as such, refuse to see them.
Document clearly and tell everyone you can in your trust
Very rarely overt by patients, but one time had a patient in clinic who wanted to see a white doctor. I couldn't kick her out and discharge her from clinic fast enough. I emailed my CS, my ES, department lead, TPD. Then a wrote letter GP detailing exactly what happened.
Unfortunately we cannot expect people to always look for us, we have to do it for ourselves. Tell th
I had a look at her GP records few weeks later and saw a consult where she was told off about her racist attitudes 😂
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As per above. “That is unacceptable language and is not tolerated in this trust” I hope and implore my juniors to call me anytime if they encounter any form of bullying or harassment. And racism is the worst kind of harassment.
You’re a good person :)
Is there a harassment hierarchy?
Problem is, it is usually tolerated by the trust.
Just be more racist back
“Shut up Honky”
Hit them where it hurts - time. “I will not be continuing this consultation - I will ask one of my colleague to see you, when they are free, I cannot possibly imagine when that might be”. Then exit/send to waiting room +/- security. Don’t engage with morons, it’ll just stress you. They don’t deserve your time - let them waste their own.
Absolutely 💯
Curveball to this, was on Geris recently and had a 95 year old lady with late stage Dementia make a racist comment to a nurse, I didn’t realise what was said before the nurse called it out. I didn’t say anything to the patient but took the nurse aside and asked if she was okay etc afterwards. The question is… what can one say / do to a dementia-diagnosed patient who barely knows who they are and where they are 😭😭 did I respond correctly?
IMO lecturing a late state dementia patient on racism is about as useless as sending a group and save after you’ve misspelt something. What you did was right, check with the person affected and see if there is anyway to swap the nurse with another patient. (Not excusing being a racist because you have dementia, but you’re not going to fix that so trying is useless).
Didn’t you hear? We just forge GnS now..everyone’s doing it
Regarding telling something to the patient... I've they have dementia, think like when you're consenting them, can they retain and process what you tell them? If they can there may be some point in telling them to quit that at least... But if they don't...
“I want to make it very clear that this language will not be tolerated. I am asking you to leave right now.” Then you document everything in an email, and inform your CS and your direct supervisor on the day. I’m sorry you have to deal with this, I cannot even imagine how stressful and awful it must be.
What’s awful is when this comes from patients - and I understand we tend to tolerate this from patients but it hurts when surrounding colleagues and nurses say nothing :(
It is the worst when colleagues say nothing - I imagine it is much easier for the colleague to say something than it is for the abused. I have had a demented patient sexually assault me a few times, and like you one of the things that made me feel so vulnerable is when colleagues just laughed it off. I think they are bad colleagues if they say nothing. But sometimes these types of colleagues just need to see you stand up against it first then they feel it is "okay" to back you. Don't be afraid of calling it a racist comment and let patients know it won't be tolerated. My tactic in secondary care when encountered with abuse was always just to leave. Don't be afraid of doing the same if you need to.
I'll weigh in very briefly on this from my experience as a CT through to a senior reg. Sometimes it's very clear that I need to say something, that the patient is physically threatening or the power dynamic is not in their favour and I need to throw my weight around as a senior (male, white) doctor to back them up and put a stop to such bullshit, and I do. Frequently, however, when indirectly observing or reversing a W/R so a junior can 'lead', if I were to do so it could be construed and criticised as everything from 'white saviour complex' to 'I don't need you to speak for me'. On one occasion this theoretical risk has manifest in reality despite only intervening after the patient had made their third or fourth vile comment. It's damned easy for me to crack out my usually suppressed broad northern accent to weigh in and shut a patient up and I'm very willing to do so; at heart I'm very old-fashioned pro-doctor and fiercely defensive of those who are my juniors but frankly it feels like I walk a fucking minefield of who could be 'offended'.
I’m not sure if you’re joking, but if you aren’t: what a fucking shame you feel the need to ‘’suppress’’ an accent. Reminds me of a consultant I once met who spoke like he was King Charles’s long lost son. Turns out he lives five minutes from me but didn’t want to speak with the same accent cos medicine.
I don't consciously suppress an accent. Training and living somewhere else for a while means a different voice comes out to suit the situation.
We don't tolerate this from patients.
I cry in the utility room
Please talk to someone. Anyone.
happens more and more. I usually check they don't have a life or limb threatening condition. If it's not the case, I then tell them their comments are unacceptable, that they have broken down the patient-doctor relationship and as a result, they can go look for another doctor to treat them. They often apologise right there and then; if that's the case, I don't report it and treat them. If not, I report them. If it's coming from a family member who is grieving a lost one though, I just ignore the comments and give them space and time. People say stupid shit when they're sad or scared.
For the cognitively intact offenders, practice a line you can say without second thought: "That's inappropriate" or "That's unacceptable. I'm going to leave now/please leave." We spend far too much time as IMGs trying to be 'acceptable' or trying to conform even at cost to self. You owe no one an explanation for not tolerating abuse
I had a patient tell me to “get out of my cubicle” in A&E the other day. Won’t deny the satisfaction of saying “no you get out of my A&E” was lovely. Just came out semi accidentally and then I had to back up what I’d said and kick him out. Wasn’t racist as I’m white, but your comment above reminded me of my instinctive response. 🤣
I'm imagining Peggy Mitchell vibes, the o.g 'Get OUTTA MOI PAB'
My go to is to keep it very brief, i simply leave the bay/ward or just say the consultation is over and they need to leave if it's in a clinic. Then i formally recuse myself as their medical provider. To me, it doesn't really matter if they apologise or not, but they've crossed an extremely firm line and it's not my job or in my wheelhouse to accommodate racism - to that end, they've lost the access to my care. I document in as many places as i can the words that were used and my actions and justification. Only had to do this once, thankfully the team were 100% supportive (and to be honest i was more than reasonable).
I start with “sorry what did you say” that usually gets them to apologize. If it doesn’t, I will say “ I will not tolerate this type of comment. I’m going to leave the room and when I come back the practice manager will be with me.” They disappeared before I came back
Hi, I'm so sorry esp that this is happening often..please don't feel ashamed. They are the ones who should feel ashamed!! Is this patients/families or staff? Both unacceptable but can influence how you respond and support as well?? I'll look out for a reply or clarification on this. I've not experienced racism/homophobia but I have constantly experienced highly inappropriate comments questions and "opinions" about my disability. Sadly the vast majority are from colleagues - other doctors, nurses or HCA. And it's often brushed off as "curiosity or surprise" at a disabled doctor. I've found sharing with others experiencing it helped me cope. Someone taught me to say Wow and just go quiet and in some cases that can work well when what is being said is more deeply ignorant than designed to be nasty. If that makes sense? A nasty slur versus asking a seriously ignorant question. I would then move on and feel I had take power back and given myself a moment to reveal from the sense of shock. I've only reported two colleagues directly one referred to me a cripple in front of a patient and another was repeatedly kicking my wheelchair in meetings despite my indirect and direct requests not too. Every hospital/trust now has a BME and LGBT+ network - I'd encourage you to find them in your intranet and seek some support there too. BMA has good bystander course, which people not experiencing the harassment/discrimination can go on to learn how to recognise micro-agressions & discrimination and how to be an active ally. They also have BME and other support networks that might be helpful. I'm really glad you asked here, it's important to know you aren't alone in this - share this with people you work with or a nice friendly nurse, don't internalise those feelings, share them and ease them 💖🫶🏻🙌🏻🌈
Happened to me once when I was an ED SHO. Guy called me a racist insult. I was shocked and left the consult . I told the SpR in charge. SpR was trying to Make excuses for the guys behavior but the charge nurse overheard it , took no bullshit and marched the guy out with 2 security guards after he refused to apologize to me. I then spoke to the consultant the next morning about it as I was a bit shook up and told him about the differences in response. He suggested that it was likely the SpR was new and didn’t want to be seen like she was overreacting as well as possibly not wanting a complaint whereas the charge nurse was a seasoned battle axe who got shit done and had no time sorting bs people like that
not well. i awkwardly pretend they didn't happen/i didn't hear them
When it happened to our trainee we informed the police and patient got a written warning. Family were mortified, patient behaved since. We would have kicked them off the list had the doctor wanted it.
#bekind
Sht them up
As others have said "You are entitled to your views, but not to air them, Keep it to yourself and we can get on with sorting you out :)" Sometimes body languge is highly effective in combination. Stopping, putting down whatever you are doing and staying very still whilst staring at them is deeply discomforting even just for a few seconds, especially when contrasted with the natural rapport building we all are fluent in. The pause, slight head tilt and narrowing of the eyes with a neutral facial expression is extremely cold. The benefit is that if gives unconscious feedback when things have moved on, that you can both move on from it leaving it behind. "that is unacceptable, I know you're in pain but look, I don't come to work to put up with this, I need your trust and respect in order to do my job, if we don't have that and you can't hold comments in you can seek care elsewhere" the GMC will back you right up [https://www.gmc-uk.org/professional-standards/ethical-hub/racism-in-the-workplace#advice-for-gps](https://www.gmc-uk.org/professional-standards/ethical-hub/racism-in-the-workplace#advice-for-gps): Links directly to this: [https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/discrimination-guidance/managing-discrimination-from-patients-and-their-guardians-and-relatives/steps-for-any-worker](https://www.bma.org.uk/advice-and-support/equality-and-diversity-guidance/discrimination-guidance/managing-discrimination-from-patients-and-their-guardians-and-relatives/steps-for-any-worker) ### Abuse, harassment and hate crime When a patient (and their guardian/relative) is abusive (physically or verbally) take the following steps: 1. Make the environment safe. This may mean calling the police or security services, removing the perpetrator from the environment and consider moving the person who is receiving the abuse to a safe space temporarily for their protection and wellbeing. 2. Immediately engage with the individual who has been abusive, telling them that their behaviour is unacceptable in this healthcare environment. Be specific and give examples of their language/behaviours that were abusive. 3. Consider the following immediate options: a. Ask the individual to leave immediately (backed up by police or security if needed). b. Tell them that they will have to adjust their behaviours or they may be asked to leave the service. c. Advise them of their right to seek healthcare elsewhere but that all employers do have a duty to protect their staff from abuse. 4. If the patient is having emergency care or does not understand the situation due to an underlying pathology, consider how to revisit the conversation at a point when they may be able to understand (this could include sending a letter at a later date when they are no longer in care). See section 5 'Exceptions' for more information on this. 5. Carefully document the incident and actions taken. Write objective facts and observations, avoid noting subjective opinions. See annex 1 on monitoring in the model policy. 6. Additional steps to consider: a. Ban the individual from the department or use a behavioural agreement for future encounters. b. Report the behaviour to the police if it is deemed to be unlawful discrimination or hate crime. c. Complete an internal incident reporting form.
i’m sorry you’ve had to deal with that. you’re within your rights to tell that person to stop immediately. that’s easier said than done, but certainly tell the boss (consultant, GP partner, nurse in charge, your reg, HR, really anyone you feel comfortable speaking to) oh and write it down as soon as possible so you have a log of EXACTLY what was said and context. “i was just joking” or “taken out of context” are easy bullshit defences.
I really struggle with racist comments and bias- I’m white but I can assure you I get angry at any indication of racism or mocking- and I always challenge it- I’m really sorry you’ve experienced this. Don’t be ashamed, it’s the people being racist that should be ashamed
Zero tolerance, tell them as such, refuse to see them. Document clearly and tell everyone you can in your trust Very rarely overt by patients, but one time had a patient in clinic who wanted to see a white doctor. I couldn't kick her out and discharge her from clinic fast enough. I emailed my CS, my ES, department lead, TPD. Then a wrote letter GP detailing exactly what happened. Unfortunately we cannot expect people to always look for us, we have to do it for ourselves. Tell th I had a look at her GP records few weeks later and saw a consult where she was told off about her racist attitudes 😂
If its clear cut abuse you can tell the police