Picture attributed to @katemangostar at Freepix
Patient-centred care is the it thing in medicine right now. From job specifications to health organisation slogans to everyday discussions with colleagues, patient-centred care is meant to be at the heart of it all. It has become the nirvana of the medical world. The peak of enlightenment. And when you look into it you can kind of see why.
The term person/client-centred care was coined by psychologist Carl Rogers in the 1950s and was used to encourage empathy and a non-judgemental approach from the treating individual towards the patient.(1) Over decades, as medicine became more holistic and less paternalistic, the ethos of person-centred care began to seep its way into the clinical sphere and eventually patient-centred care was enshrined into hospital doctrine when it was utilised by the Institute of Medicine in 2001.(2)
As with most concepts, patient-centred care is constantly changing, and the infographic below demonstrates its key tenants as most medical professionals would define them today.
Now, you’re probably wondering why I’ve lured you in with a wonderfully clickbait-esque title, only to wax lyrical about how patient-centred care is the cornerstone of modern medicine. But the thing is, as much as I appreciate and uphold the tenants of patient-centred care, I think they have inadvertently enabled and supported the systematic denigration of, and unashamed racism towards, health professionals of colour. And I think we are doing society, the health care system and the minds who envisaged patient-centred care a disservice if we continue to ignore it.
“No offense love, but can I see a white doctor”
“Oh…you’re my doctor….is there anyone else I can see”
“Any chance I could have a nurse who actually speaks English?”
“I don’t want you to take my blood…where’s that nice white doctor from yesterday”
What do you say to this?
What do you say when the care you're trying to give is rejected based on the colour of your skin?
What do you do when you know everyone has heard but no-one says a word?
What do you do when you feel shame and embarrassment creeping up your face and for a second are relieved that your dark skin hides your flushing cheeks?
What do you do when there is no system or structure in place to enable you or others like you to navigate these situations?
What do you do when medicine teaches you that the patient’s ideas, concerns and expectations are the most important things for you to address?
What do you do when patient-centred care tells you that you need to “respect and value your patient’s viewpoint” and place their “emotional well-being as a top priority”?
Well, in my time I’ve been fortunate enough to come across some recommendations from well-respected and frequently utilised resources:
Compliments of ISC Medical – A Comprehensive Guide to CT, ST and Registrar Interview Skills (2nd Edition)
Excerpt from an email conversation with a member of the General Medical Council (GMC) Standards team regarding the aforementioned interview skills question and answer
As you can see, the overarching theme from the powers that be is that the patient comes first, your sense of worth, humanity and mental health second. The central focus and perceived victims of these instances of racism are not the doctors, but the patients. The objective is to ensure that the patient is being treated with fairness, courtesy and respect, but not to afford health care professionals that same treatment. The aim is not how to support the effected doctor who has been racially abused, but to make sure that patient-centred care is upheld at all costs.
In addition to this, the fact that prior to 2020 there was no national guidance on how to address these situations further reinforces the idea that health care workers of colour, and the issues that affect them, are unimportant to the government and wider healthcare structures. As of this year racism and sexism are to be included alongside verbal and physical aggression as reasons why a person can be refused non-critical treatment. (3) Prior to this you could be denied treatment for repeated telling someone to fuck off but not for repeatedly calling them a nigger, paki, chink or whatever racial slur took your fancy at the time. Go figure! But I suppose when the rules are written by white men, for white men, these “nuances” tend to get forgotten.
However, what we cannot forget is that hospitals do not exist outside of society. If anything, they are a microcosm of both the wonders and horrors that exist in the world around us. Therefore, if we accept and pander to racism in the health care setting, under the guise of patient-centred care, then we are accepting and pandering to racism in society. By indulging these people in conversation, and allowing their racist wishes to be enacted, we are telling these individuals that the national health service supports their ideology that people of colour will never be as good as white people. And this is what leads to the death of black people the world over. The constant, subtle affirmation that whiteness truly is the benchmark of supremacy, alongside the pervasive, unchallenged dehumanisation of black people in all spheres of life. If you don’t see someone as human, then you will not treat them as such, and the process of stripping away a person’s humanity is often not noticed by those doing it until there is nothing left.
You may think I’m over-exaggerating, but if you’re of the opinion that the brutalisation of black bodies has come from nowhere, and that the racist systems of oppression that are present in the healthcare system and beyond, either don’t exist or have nothing to do with the current state of the world, then you need to educate yourself. The victims of racism don’t need your generic hashtags and knee-jerk reactions. They need your dedicated and sustained action. And for those of you in health care, you are frequently placed in positions where you can act, defend and support your colleagues of colour, if you make the active decision to do so.
References
2. Institute of Medicine (2001). Crossing the Quality Chasm: A New Health System for the 21st Century