The shocking case of two Filipino nurses attacked during riots in Sunderland last week prompted Health Secretary Wes Streeting to announce that those who are racist towards NHS staff “can and should” be seen to be free from action.
While I agree with Streeting that those who attacked nurses “brought enormous shame to our country,” when it comes to turning away patients, I couldn’t disagree with him more: It’s not up to the doctor to make a moral judgment about who can and cannot receive treatment.
Like Streeting, I was horrified by the scenes in Sunderland. It is unbelievable that good, kind, caring people trying to get to work to help others should be subjected to such abuse.
But being racist shouldn’t mean you can’t get treatment on the NHS.
In my 20 years as a doctor, I have encountered many cases of patients who are racist, homophobic or misogynistic. Some have expressed truly vile beliefs. While I wouldn’t say this is common, it is certainly not uncommon.
I have treated murderers, rapists, pedophiles and terrorists.
But it’s a slippery slope to start making moral judgments about who can or cannot receive treatment based on what they believe.
If we start excluding racists, where does it end? What about other things that the doctor might not agree with? What about climate change deniers, or people who eat meat, or people who disagree with abortion, or any other controversial issue where one person finds another person’s views offensive and unacceptable?
In my first year as a doctor, I remember a patient who refused to be treated by black staff. He suffered from urinary retention, meaning his bladder did not function properly, a terribly painful condition.
It was the middle of the night and I was called to insert an emergency catheter, but I had only practiced on a plastic model.
The other attending physician on duty with me, who was black, was very competent and the patient suddenly reconsidered his racism when faced with the choice between having something injected into his penis by someone who was white but a complete novice, or a black person who actually knew what they were doing. So I helped my colleague and the man was very grateful to both of us.
After the catheter was placed, we spoke to him about how everyone deserves to be treated with respect at work. We helped him see that by refusing care from black staff members, he was not only creating an unpleasant environment for them, but was also affecting his own care. He later wrote a letter of apology to the ward staff for his behaviour.
Wasn’t that a better outcome, both in terms of medical ethics and changing someone’s mind, than simply denying treatment?
It’s not just white people I’ve seen acting racist. I work in multicultural London and I’ve seen Ethiopian patients insult Eritrean staff, Pakistani patients attack Indian staff and Muslim patients make horrible comments about Jewish doctors. One Turkish patient refused to be treated by a gay Turkish nurse because he thought the nurse was bringing shame to his family and country.
I have had several patients who have said homophobic things in passing, using offensive slurs in conversation, and I always stop them, explain that I am gay and that it is quite difficult to hear such things. They are often shocked.
“Oh, but you’re fine, doctor,” is a typical response, as if that makes him feel good.
I have a policy of talking to them about how these attitudes can be really damaging and disturbing. You don’t change patients’ minds by banning them, as Streeting would say, but by showing them unequivocal kindness, compassion and care.
Health Secretary Wes Streeting said those who are racist towards NHS staff should be denied care.
It’s not always easy. I was recently with a staff member speaking to a patient who had been convicted of a violent sexual offence and who described women who did not wear hijab as “sluts” and deserving of rape. Surprisingly, he was quite outraged at having been convicted of rape and said it was the fault of the men in this country for allowing “their women” to go out on the street alone, letting them dress however they wanted.
This kind of shocking misogyny is not uncommon. I always question it. Often these patients have never heard opposing views; it is cultural to them and they simply don’t realise that women are treated the same way in Britain.
On one occasion, when I was a junior doctor working in the operating theatre, I had to examine a particular patient. Within a few hours he was in the ward, recovering from appendicitis, which would have been unremarkable except for the prison guards who accompanied him and the handcuffs he wore. He was a convicted murderer. He had been taken to the hospital for treatment and was promptly returned to prison when he had recovered sufficiently. The treatment he received was exactly the same as that of any patient with appendicitis. The fact that I and the other surgeons were morally opposed to murder did not matter.
Sometimes, yes, it tests your tolerance to the limit. A friend of mine, who worked in the emergency room, had to stitch up the hand of a man who had repeatedly punched his wife in the face. Even though she hated being in a room with him, she knew that, as his doctor, she had to treat him anyway.
In medical practice there is no place for value judgments based on issues outside the clinical field. Our role is to treat, not to judge.
Pain like Kirsty’s is all too real.
Presenter Kirsty Young says a doctor made her feel “crazy” by telling her the condition causing her chronic pain (fibromyalgia) didn’t exist. This is in line with what many patients I’ve seen over the years who seek help for chronic pain say.
It’s very easy to ignore pain when there’s no clear underlying cause to explain it. I think part of that is because pain is so complex: there are no objective tests for it, and it’s not clear why some people experience it so differently from others. What’s more, sometimes no underlying cause for the pain can be found, but the person is severely incapacitated by it.
Kirsty Young says a doctor made her feel ‘crazy’ when he told her her fibromyalgia didn’t exist
However, we know that there are things that can help besides the usual medication.
People with chronic pain who are lucky enough to be able to see a specialist are often surprised to find that they are offered psychotherapy rather than simply more and more painkillers. This is not to say that their pain is “all mental.” Problems such as sciatica, fibromyalgia, and other chronic pain conditions may be the result of a complex interaction between physical and mental states. Studies have found that emotional and physical problems are processed in the same part of the brain, and it is likely that chronic pain is actually a “mind-body” condition, with emotions playing a major role in triggering or exacerbating pain.
This is not about dismissing anyone’s genuine suffering.operating systemHow we feel mentally can have a huge impact on how we experience pain.
For years, menopausal women were treated very poorly by the medical profession. They were denied HRT and their symptoms were downplayed. But have things gone too far? Dr Sue Mann, the NHS’s first national clinical director for women’s health, has said that there is now a perception that “everyone should be on HRT” and that menopausal women feel they are “missing out” if they are not prescribed the medication. I have to say that I agree. While I regret the fact that doctors have been so cautious about HRT for so long, and that women have no doubt suffered as a result of this, the current trend of giving everyone this medication is equally wrong.
There are a wide range of treatments and interventions to help women going through menopause, from cognitive behavioral therapy to medications that target specific symptoms, such as Veoza, which treats hot flashes and night sweats. These are just as valid as hormone replacement therapy. Every person is different.rent and we need to give women all the options to find what works for them.
For all the excitement surrounding new Alzheimer’s drugs such as lecanemab and donanemab, experts warned last week that they are likely to produce little improvement in symptoms and only in the early stages of the disease. And it will take considerable resources to identify candidates, infuse them with the drug and monitor them for possible side effects. While they are a major step forward in the battle against this terrible disease, I fear that there has been a lot of hype around them and that the search for a cure continues.
Dr. Max prescribes: Fruits and vegetables.
Vegetables and fruits contain a wealth of disease-fighting nutrients and antioxidants.
You’d expect that there would be no need for advice to eat fruit and vegetables these days, but according to the latest research, the average Briton goes a month without eating a single piece of fruit and three weeks without eating a green vegetable. Honestly, this is shocking! We know that fruit and vegetables contain a wealth of disease-fighting nutrients and antioxidants, as well as fibre, which helps our gut and protects against cancer. So, let’s get our hands on (green) food this summer!