Being Brown and Black in the NHS and Blame Culture


In August 2018, we saw junior doctor and training paediatrician Dr Hadiza Bawa-Garba win an appeal to practise medicine once again. She initially lost her license to practice and was struck off the medical register. She was initially sentenced to a 12-month suspension after being convicted of manslaughter by gross negligence of six-year-old Jack Adcock in 2011 who died of organ failure secondary to septic shock. The General Medical Council (GMC) appealed against her suspension and called for the high court to permanently strike the doctor off the medical register. Her case sheds light on an important matter in the NHS: are brown and black doctors held to higher standards than their white colleagues? What does this mean for current and future BME doctors alike? How do we balance this with needing to assure patients that their care and safety is our highest priority?

Jack Adcock was admitted to hospital and entrusted into the care of Dr Bawa-Garba who had just returned from maternity leave. It was revealed that her three colleagues were away for much of her shift and there was a critical IT fault in the time leading up to Jack's death, combined with there being other critically ill children on the ward under her care. Apart from this incident, the competence of Dr Bawa-Garba has never been brought into question and she was succeeding in her pursuit of becoming a paediatrician. By no means should the gravity of the death of Jack Adcock be diminished but in medical school, we learn that medicine is more than a matter of spot the textbook manifestations of a disease. It requires precision and the ability to pick up on details (which is physically and mentally demanding to sustain at a high standard) that if overlooked can be costly for the patient. Unfortunately, this was the case for Jack whose death was deemed to be preventable.

However, we cannot ignore that in the journey to becoming the best doctor possible, due to doctors being human, mistakes are made. The reality is some mistakes are more costly than others but isolated incidents of different mistakes can provide crucial opportunities for doctors to learn and overcome. The fear of losing our ability to practise medicine should not supersede openness and accountability for mistakes and shortcomings made in medical practice. Ultimately, this creates a learning environment which fosters the growth of doctors for the overall benefit of patients longterm. This includes doctors of colour, too. Dr Bawa-Garba highlights an unfortunate truth: BME professionals are often held to higher standards of practice than their white counterparts. In scenarios where white doctors have been negligent in practice, they are rarely reprimanded as severely as doctors from ethnic minority backgrounds. In other words, the system seems to be much less forgiving if you are brown or black.

Because of the wider issue of discrepancy in doctor accountability, doctors all over the nation condemned the stance of the GMC and the high court. We saw over 1,500 doctors and unions such as the British Medical Association (BMA) speak up against the decision made against Dr Bawa-Garba saying their decision to strike her off was unnecessarily severe and they raised funds allowing her to be able to appeal the decision in court. If BME doctors were held to the same standards of practice it is very unlikely we would have seen such a large outcry of support for Dr Bawa-Garba in this case — if there were to be such a case at all.

Caring for patients with complex morbidities has been an increasing burden for junior doctors over the years which has been a cause of concern. Is it fair to expect so much of junior doctors on their own? Is it safe for the patients? Are we creating an environment for patients by leaving them in the principal care of junior doctors who are also being overworked? Perhaps if the burden of the ward was distributed more evenly among colleagues, Dr Bawa-Garba would have been more able to attentively care for Jack Adcock which would have prevented his death. The staffing crisis in the NHS means it is difficult to adequately care for all patients at all times simply because staff are strained. This is across the board: doctors, nurses, occupational therapists, pharmacists and more. The notion of the NHS workforce being overly burdened with more than they can handle further reinstates that negligence is not always the sole fault fo the doctor in question; the work environment must be conducive for this also and so this must be reflected when doctors are reprimanded.

We cannot ignore discrepancies we see in the treatment of NHS doctors of different ethnic backgrounds. Racial biases exist in many institutions that permeate all parts of society and regularly negatively affect people of colour: some being the NHS and the GMC. From this case, we can see that we can change this narrative for a better outcome for all doctors present and future by speaking up and using our collective voice. If not for doctors nationwide the story of Dr Bawa-Garba would have ended quite differently. If we stay silent on matters affecting others in our community, we will struggle to see positive change for BME professionals in and surrounding the healthcare sector we so desperately need. The outcome of this case is a step in the right direction and makes me optimistic for the future and hopeful for realising an institution in the NHS which is fair to all, committed to seeing a learning environment which is open and conducive for the welfare and practice of all doctors; BME doctors included.

For the source used to inform this post, click here

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