Dr Amir Khan is a full-time NHS GP and best-selling author working in inner-city Bradford. He is also known as a podcast host, a resident doctor on TV, and his insightful, practical advice about everything from sleep to menopause has garnered him 1.1 million followers on Instagram.
In his latest column for The i Paper he shares how anti-immigrant rhetoric is directly affecting frontline NHS workers, including him. Interview by Sadhbh O’Sullivan
Last month, a survey from the Society of Radiographers found that NHS staff are facing worsening racist abuse following the rise of anti-migrant rhetoric. I’ve been working in the NHS for 22 years and have seen this first hand – most recently, just a few weeks ago.
It was a normal morning at my GP surgery but I could hear a patient shouting in the waiting area. He was so loud that I could make out what he was saying from my office: that he needed an appointment that day, but that he “wouldn’t see a P**i doctor”.
He had put in an online request for an appointment that morning for an issue that was medically minor, but was bothering him significantly. Now he was demanding he see someone immediately, and it escalated. He said he’d seen a Pakistani doctor every time he’d been here “and they’d been shit”.
This is at a GP surgery in Bradford, a very diverse area, in the middle of a waiting room full of patients including children.
The shouting brought me out of my office and I tried to get him to calm down: I’m a partner at the surgery and I was standing up for our staff who were at this point intimidated. Then he turned on me and said over and over, “I don’t want to talk to you, I need to speak to a white doctor”.
I wasn’t able to really digest what was happening, I just told him that he had to go and if he didn’t we’d call the police. He did, but later came back spouting the same thing about only wanting to see a white doctor. That time my colleague did call the police and he left and didn’t come back.
It is not the first time I’ve experienced racism at work, but it’s still so shocking and humiliating when it happens. My next patient was in that waiting room watching me being abused. You have to take that deep, deep hurt and put it to one side so that you can be 100 per cent there for your patients.
A GP surgery is a busy place and you don’t have time to dwell on these things. But it affects you long afterwards. It’s made me hypervigilant recently, on the look out for small changes in behaviour in patients, watching the way they’re looking at you. I’d find myself asking, “Are they looking at me because I’m brown?” It’s exhausting and after a while can make you disengaged. For weeks afterwards, you have a level of anticipatory anxiety that it’s going to happen again. It’s always in the back of your mind.
But equally, I owed it to myself and my colleagues to make sure this is properly accounted for.
We did a written report and formal interview with the police, and then had a partners’ meeting where we discussed it and agreed to remove the patient from our surgery. Having to bring what he was saying to the meeting and then debate it was exhausting. There wasn’t a huge range of opinions, but there there was a little bit of pushback from others: should we try and understand? Is it his first offense?
Given he didn’t have a life-threatening emergency and had been threatening me, I felt that he’d forfeited his right to care from us. We left it with a warning on his record; he now has to register at a practice in central Bradford which is specifically for patients who can’t register at normal GP surgeries.
Of course, if anyone comes in with a life-threatening emergency, we would treat them no matter what they were saying. But when it is a non-emergency, as it was in this case, we can refuse. The NHS has a zero tolerance policy and because I’m a partner at my surgery, I was able to ensure that policy was followed through. But it doesn’t always happen.
When I worked as a junior doctor in hospitals, I’d often see that when there is abuse, particularly racist abuse, there is a form of tolerance: everybody just quietly rearranges the clinician that that patient is seeing to accommodate them. There’s nothing more humiliating, it leaves you feeling completely devalued. And I know that this still happens now.
Working on the front line of the NHS, we develop a thick skin. Dealing with abuse, and people’s frustration, is unfortunately part of the job. As a doctor, you always think about what that patient has been through. In this case, he had a painful medical condition that was bothering him, and I found myself thinking, “He’s in pain, he wants an appointment, he’s just frustrated.” I realised I was making excuses for him and had to stop myself – there’s no illness that just makes someone racist.
Racism is thankfully less frequent than general abuse, and it’s not the majority of patients who act this way, but the number of people who feel empowered to use this language is increasing. It’s not surprising in this current climate. The NHS doesn’t exist in a vacuum. It’s a reflection of wider society and when we hear language that has been otherwise unacceptable for many years enter the public discourse, of course we’re not going to be insulated from it. I see certain politicians on social media now speaking in ways that I would never have dreamed of hearing 20 years ago. As it gets normalised and bleeds into our consulting rooms, we’re expected to just deal with it.
I don’t come into work thinking that I’m the child of an immigrant. But the anti-immigrant and racist rhetoric is so pervasive that I feel much more conscious of it now. I’ve heard people in the waiting room complain that we’re prioritising immigrant patients over white patients. We’re not – everyone finds it equally difficult to get an appointment! Actually, the truth is that the only reason you can get an appointment is because of people of colour like me who are working to see you. But knowing this doesn’t make it any easier when you are reminded that people think you are less than because of the colour of your skin.
As a doctor who has been in the media and on TV, I have been the “good immigrant”. I’ve shown that I’m good enough to diagnose you, treat you, be on TV, look after your relatives and entertain and educate you online. Increasingly people of colour in this country have to prove their worth by means of their jobs or how much they contribute to society, a burden that is not carried by white people.
To be clear, nobody should be carrying this burden. But even if you meet that standard, you still get these reminders that some people still feel, despite all of that, despite all the integrating and aligning with Western values, you’re still not good enough to be here.
I’ve given up jumping through those people’s hoops. I’ll always be nice to my patients and do my best, but I’ve given up trying to understand people when they abuse me. If we’re putting it in health terms, the racist abuse of NHS staff is a late symptom for a much more serious disease and we need to catch things early. Prevention is key and we have to make it clear at every instant that this language is not acceptable, not just in the NHS, but everywhere.
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