Issue 34 / 9 September 2013

SOME years ago, while enjoying a cathartic session over coffee with a fellow junior doctor, my colleague asked me about the ethnicity of a nurse.

Although I no longer remember the context of the question, I do remember I could not give an answer. I had worked with the nurse for almost a year and was surprised I did not register her ethnicity. Later I consciously “looked” at her and realised she was of Indian heritage, with a subtle accent and a darker skin complexion.

Was I “colour” blind? But that was in a different era, a different country and a different life.

I have been in Australia for more than a decade and have come to accept that here the ethnicity of a person does play a role in daily interactions. It is not a topic of polite conversation but it is certainly something frequently discussed in euphemism and double entendre among “ethnic” individuals that have experienced it.

As Associate Professor Charles Teo puts it, it is not right for people who aren’t of Asian appearance to say that there’s no anti-Asian sentiment in Australia. Unless you’re Indian you can’t say there is no anti-Indian feeling.

Discrimination in any form is not often easy to prove. Be it racism or sexism, the impugned conduct is sometimes done in a passive–aggressive manner and without the use of vilifying words. It may be in the body language, the tone of voice, or just blatantly ignoring the contribution or presence of another human.

Are we as health practitioners complicit in doing nothing about racism in our workplaces? Do we think that those who complain are being overly sensitive? Or should we acknowledge that we need to be more sensitive to those around us?

Recently, I had the unpleasant experience of observing a very senior physician in the emergency department publicly chiding another doctor in front of patients. Because I was only a casual staff member and felt ignorant of the political nuances, I later asked the doctor why she allowed herself to be treated that way.

The apparent reason for the tirade was for a management plan that, given the clinical context, seemed entirely proper by any reasonable standard. I learned that the victim was a very experienced doctor who knew what she was doing.

She lamented (in euphemisms and the unspoken words) that this senior doctor treats different individuals differently.

Once again, I removed my colour blinkers and opened my eyes. I began to observe the senior doctor and what I saw disgusted me. Every interaction this senior doctor had with another doctor of an “ethnic” background (from the very junior interns to the senior registrars and career medical officers) was either with a body language of sullen disinterest, patronising tone of voice, or blatant disregard.

This was in sharp contrast to a bright cheery intonation and body language showing genuine interest when speaking to another doctor of Caucasian heritage.

Speaking to several lawyers and researching processes in the health system, I was disappointed to discover that there is no gentle way of drawing attention to unacceptable behaviour without a “formal” adversarial approach. Given many of the leaders of medical departments are white, or may be the actual perpetrators, it really leaves no avenue for ethnic doctors to voice their experiences.

This not only affects recent migrants but also those who are long-time residents or Australian-born.

Being an optimist, I like to believe that those who behave inappropriately do so out of either ignorance or lack of self-awareness. Either way, it does not devalue the experiences felt by those affected.

In some non-medical companies, there are processes to allow confidential discussions and for the issue to be raised privately and confidentially with the perpetrator and, if required, for the perpetrator to be counselled.

Perhaps it is time to implement a similar process in the public health system. Or, if there is already a process to deal with this problem, to make it more readily available to those who need it.

As clinicians, are we putting on our objective evidence-based lenses in assessing discrimination rather than listening to the voices of those who experience it daily but do not feel empowered to speak up without risking their jobs?

As doctors we are constantly seeking cures for those afflicted by diseases, both physical and mental. Perhaps discrimination is another “ism” we need to start addressing.

Dr Benjamin Koh initially trained as an orthopaedic surgeon before combining his experience as an elite athlete to focus on sports medicine. He practises in Sydney.


Is racism a problem in the medical profession?
  • Yes (53%, 89 Votes)
  • Yes - but not widespread (33%, 56 Votes)
  • No (14%, 23 Votes)

Total Voters: 168

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8 thoughts on “Benjamin Koh: Confronting discrimination

  1. Could our divisive monocultural schooling system be a factor says:

    In Sydney, half of our school students are of language backgrounds other than English (LBOTE).  This did not happen overnight.

     Unlike other countries where almost all school students attend fully government-funded co-ed comprehensive schools, we create divisions of gender, early academic test levels, religion, socio-economic background and ethnicity.  Our schools are far more marketised and culturally divisive than those of most other OECD countries.  Are we excelling in nurturing prejudice each day in too many of our schools by offering skewed, one dimensional social interactions? Are we creating limited and fixed mindsets?

    It seems the growing bigotry and intolerance of Australian society generally is even an issue among our medical and health professionals. Yet this divide should be negligible since high intelligence is supposed to predispose one to a greater sense of justice and a lesser tendency to irrational judgements as described by Dr Koh and other commenters.

    Given the increasingly poor socialisation environments and one upmanship of most of our selective and private schools, problems of perceived differences will only escalate. 

    And are our brightest and most well suited students becoming doctors if a noticeable proportion of our medicos lack the common traits of intelligence???


  2. Belinda Cochrane says:

    I have no doubt that racism exists in the Australian health system but will speak to the point made by Asclepius about referrals made by doctors with accents (from the point of view of the recipient). I am a staff specialist in medicine and receive telephone referrals from the emergency department doctors frequently, more often than from medical registrars. That is an issue in itself; ideally proposed medical admissions should have been assessed by the highest ranking medical doctor in the hospital and omitting that step by calling a specialist who is not on site goes against the principles of best practice. Even if an ED doctor is experienced their training, role and priorities are different from those who are trained to care for these patients throughout their hospital journey.  There are several issues about receiving telephoned referrals, whether the referrer is accented or not. As someone in receipt of these calls, it’s important to point out that, from my point of view, it is not the presence of the accent that affects the diffculty in making the referral but whether the referrer is easy to understand. The referrers seem to forget that telephone conversation is more challenging, as the usual social cues of gesture and facial expression, which can help explain a point, are entirely lost. As an example, I was on call a few nights ago and received a phone call which woke me from sleep. The referrer did not take time to orientate me but proceeded to quickly start talking about an asthmatic who needed admission. However, I really struggled to understand the referring doctor because of his accent. I was worried that the patient needed HDU not just admission. Bottom line – I asked for second opinion rather than risking the patient’s safety!

  3. Yung Yap says:

    I applaud Benjamin for speaking up. I have worked in the public health system, and can see that racism is so widespread but subtle. If a caucasian doctor makes a mistake, s/he will find reason to pass on the blame to an ethnic doctor even if the ethnic doctor is the one who has identified and rectified the mistake! But caucasian colleagues seemed oblivion to this, and continue justifying their passive-aggressive behaviour.  A common example of subtle racism: If you see someone of non-caucasian complexion and ask for their ethnicity, one would expect an answer like Indian, Vietnamese, Aboriginal etc. If the same scenario applies to a Caucasian, the answer may be Australian. I wonder whether Australian is considered an ethnicity or a nationality. Examples made by Benjamin are so true, and anyone working in the hospitals and denying experiencing any of the examples is to me a racist in denial or in complete ignorance. With these racist events happening so rampantly, it is no surprise why staffs of similar ethinicity are sticking together – it is not because they don’t want to integrate, but simply because they don’t want to be ridiculed and be patronised because of their ethnicity or accent. They are like any decent human being, be it caucasian or not, who would like to be respected for who they are and the quality they possess. Why aren’t we seeing a white Australian sticking out with a group of Asians? Can we term white groups as reverse ghettos? We should all feel proud of our heritage and our accent, because this reflects the true maturity of a multicultural nation, not a white supremacist country of yesteryears.

  4. m.j.pitney says:

    We all have to carry our own crosses and accept that not everyone will like us..that’s why we have family & friends…to blame all antipathy on racism is irrational and avoids personal reflection on our own shortcomings…..mycosis

  5. Curtin University Library says:

    I still face racism at the university where I have been employed for years. Prior to this, I faced racism in the CSIRO where I was holding a senior position. Some of my previous PhD students who got their PhD from my laboratory are full professors/Directors of Research in Canada or the USA. I have an MBA in addition to my PhD and yet no leadership roles are ever assigned to me. I have nearly 100 publications in international refereed journals and yet I am still sitting at a lesser position than my previous PhD students. Of course, the students holding senior academic positions are of Anglo-Saxon or Ukranian origin!

  6. Jawad Munef says:

    My question, is the vote to prove there’s some degree of No Racism or it is a denial phase of the truely existing racism?  I guess those who vote no are new IMGs trying to fight for a seat in the health system career 

  7. Anthony Zehetner says:

    I do not feel that racism is confined to the medical profession. In many hospitals there are cliques of cultures and people of similar nationalities who band together and do not socialise with other racial groups (themselves being regarded as a population minority group but over-represented in the local workforce). Often in tearooms and corridors a furtive foreign language is spoken only to hush up when an employee of a different nationality walks past. I have been the victim of “reverse racism” — born in Australia of parents with mixed heritage (Asian and European) so thought to be a “foreigner” when I am as ‘true blue’ as everyone else. Often the discrimination comes from the so-called minority ethnic groups — at a hospital in Western Sydney the staff spoke to me in my mother’s native tongue (which I don’t speak or understand), used inappropriate cultural terms of endearment and they even wrote notes for patient handover in their own language. I found this very uncomfortable and it potentially compromised patient care. There is also the culture of “cover up” amongst some ethnic groups. The best groups I worked with were of mixed backgrounds like myself — Asian-appearance doctors who were educated and grew up in New Zealand and Scotland and identfied with those cultures (they were often ostracised by ‘mainland’ born Asians), a Ugandan who ran a Thai restaurant on the side, a tough yet gentle ED doctor from Trinidad, etc. I do feel that there is an overrepresentation of certain “races” in Medicine, asians and whites included, and advocate for integration rather than cultural cliques. Remember a time when it mattered more if your were a Sydney Uni graduate or UNSW? 

  8. Numan Kutaiba says:

    As a new migrant doctor, I can add that I have experienced racism not just because of the way I look and the color of my skin, in many occasions it was the way I spoke. Making referrals to speciality unit for patients in the emergency department was a big challenge. As soon as someone on the other end of the line hears your voice and recognizes that you have an accent, they will torment you with unnecessary clinical questions, give you grief for not checking this or that, ask you to check with another doctor (even if you were a senior doctor) and sometimes ask you to make a referral to another speciality unit to see if they would accept the patient. I make this comparison to referrals to the same doctor from caucasian junior doctors which possibly take less than a minute to make!

    As far as I have seen, this comes from ethnic doctors who were born and/or raised here in Australia too. I was once told by such a doctor that he would percieve a medical referral from any doctor with an accent as a “dodgy referral” as soon as he hears an accent!

    It is true that migrant doctors and nurses are new to the system and might not be familiar with the different aspects of health care here, but having support is just not enought. Australians will need to be more welcoming and accepting of other people and put on their “color-blinkers”.

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