Dr Harun Khan discusses persistent racist, sexist and classist stereotypes amongst some doctors @xoharun

Speaking about racism in healthcare, as a South Asian doctor, feels odd. On the whole, we hold such a strong, visible presence in the NHS that hospitals are, arguably, a Purell-smelling safe-haven for us doctors. Sure, two [too many] patients have refused to see me as I’m not white, but generally we are perceived as a “model minority” within hospitals – a sub-population of non-white folk who are largely spared from stereotypes that threaten immigrant populations within the UK. But does our overwhelming presence within hospitals protect our BME patients from the same racial stereotyping?

Not from my experience.

The clear difference between BME doctors and patient populations is social class – BME patients in the UK are more likely to live in poverty compared to their white counterparts. On the other hand, non-white doctors are overwhelmingly middle class and possess a social status that more than rivals the average British white person. We belong to a subgroup of ‘superhero’ immigrants – praised for our educational attainment, socioeconomic status and our perceived cultural integration.

This clear difference between “us and them” on the wards creates a space for discriminatory stereotypes, targeting solely BME patients, to exist. An example of a racist and sexist stereotype that exists within some British inner city hospitals is “Mrs Bibi (or Begum) Syndrome.”

This “syndrome” was introduced to me by a Pakistani senior doctor during the morning ward round. He was mockingly describing a “well-known” make-believe syndrome where elderly, [non-English speaking] South Asian woman exaggerate their health complaints despite having minimal objective signs of ill health. The only problem with his assumption was that this woman had an acute finding on her subsequent CT scan and required elective surgery.

Since then, his remarks have been echoed frequently by both my non-white and white colleagues. The same colleagues who almost exclusively make these ill-judgements based on poor quality interactions with patients with whom they do no share a common language. Unsurprisingly, the “generalised body pain” turns into “abdominal pain after eating” with adequate translation.

Despite engaging in casual stereotyping [for personal amusement], from my experience, all doctors will still go on to request the appropriate medical investigations for their patients – reflecting a clear dissonance between their speech and their actions. Whether this reflects their racism/sexism – passed off as “banter” – their personal doubts leading to fear of medico-legal prosecution, or their mere disrespect of NHS resources, is unclear to me. Nonetheless, if our patients still receive the healthcare they require, what are the problems with such ‘harmless’ stereotyping?

One well-meaning white colleague did speak to me about my discomfort with this stereotype. “Harun, it doesn’t have to be discrimination. South Asian women could have different experiences of pain – either stemming from genetic, or even socio-cultural, differences [paraphrased].”

My response remains the same. And it is important to be clear. The creation and persistent use of “Mrs Bibi/Begum Syndrome” served and serves absolutely no benefit to brown women except to undermine them.

Instead of doctors interacting with patients from a place of neutrality, this term helps silence the voices of brown women and reaffirms the racist and sexist notion that “they all” behave as a monolith even in reference to their health-seeking behaviours.

At the same time, this term is used to offer amusement to those benefiting from systems of racism, sexism and, in many cases, classism. Naming the so-called syndrome “Bibi” and “Begum” – common surnames for females of South Asian descent – reflects this. No-one using this term has ever intended to understand the health needs of this population in order to improve their public health. And the attempt to justifiably frame an ill-intentioned term, used solely to undermine the health complaints of minority women, in a positive light is orientalist at best.

Moreover, using your anecdotal clinical experience to judge “that brown women do complain about pain a lot” does not show you to be a well-seasoned clinician, but reflects that you are only concerned about the health needs of minority women when attempting to stifle conversations relating to discrimination.  As shown in high quality health research in the USA, implicit bias relating to race and sex does negatively affect the way non-white women are medically treated – for example, African American women are less likely to be referred for invasive cardiac procedures when presenting with similar symptoms and test results to their white counterparts – despite African American women being at an increased risk of cardiovascular disease statistically.

Furthermore, instead of using our unique position to promote the health needs specific to BME patients, some minority doctors help reproduce racist and sexist tropes that target immigrant communities in an effort to distances themselves from the likeness of their patients. By propagating these narratives, not only do we risk overlooking the very dire public health needs of some of the most vulnerable communities the UK, but, on a population level, we pave a pathway for white and male doctors [amongst others] to openly participate in a system which further disadvantages brown women. It also does a grave disservice to the cultural and political context with which non-white women, including South Asian women, exist in the UK today.

Looking back, I was alarmed that my senior colleague had made these remarks in a hospital where I speak some variant of Mirpuri/Punjabi/Urdu daily – given the high proportion of South Asian patients under our care. But, on reflection, it was clear to me what he was doing: after all, we are from a breed of ‘superhero’ immigrants who continue to benefit from many social privileges, but we will never truly attain the heights of whiteness. Without throwing our own under the bus to show our loyalty, how else will we truly prove to the majority that we are, in fact, the same as them?

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Harun Khan is currently working as a junior doctor in the NHS and is passionate about issues relating to global health and social inequalities. He aims to use his clinical work, public health research and writing as a means of advocating for the most vulnerable communities worldwide. In summer 2017, he launched a non-profit, journey2uni.co.uk that aims to support students from low-income communities pursue higher education within the UK.

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