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Ethical dilemmas: How should I... deal with a racist patient?

Since October 1999 the NHS has had a zero-tolerance campaign against all violence and intimidation of staff, yet the problem of racist behaviour in the workplace continues.

The 2022 NHS Staff Survey revealed that 8.3 per cent of staff reported personally experiencing discrimination at work in the previous 12 months from patients and other members of the public, mostly due to their ethnic background (up from 7.9 per cent in 2021). Some 19.9 per cent of BAME staff reported experiences in that period.

In a 2022 data analysis for NHS trusts, the NHS Workforce Race Equality Standard (WRES) report found that one in four NHS staff have experienced abuse or harassment from the public, and as many from other staff.

Racism is not something healthcare staff should ever have to tolerate and ill health should not be an excuse for racist behaviour. The Medical Defence Union says racist patients “should be challenged about their behaviour” and at a recent GPhC roundtable event to discuss how racism manifests and affects pharmacists and pharmacy technicians, delegates stressed that employers also need to take action when they see staff on the receiving end of racist behaviours from patients. 

Act quickly and be an ally

“The workplace must create a culture of zero tolerance [of racism], which is clear to colleagues and members of the public using pharmacy services,” says Amandeep Doll, RPS head of engagement and professional belonging.

Depending on the severity of the behaviour, Ms Doll advises the following immediate options:

  • Ask the individual to leave immediately and, if needed, call the police if your safety is at risk
  • Inform the person they will have to adjust their behaviours
  • Advise them of their right to seek healthcare elsewhere if they’re not going to change their behaviour. 

Step in quickly and show support for the victim. It can be a real shock, so support from colleagues is very important. Tell the victim to step away and deal with the patient instead, making it clear their behaviour is unacceptable.  It is also important to keep a record of the incident with as much detail as possible: where and when it happened, and the exact phrasing of the words used. If there are other people present who witnessed the incident, make a note of their names as well.

Reporting racial harassment

Anyone experiencing or witnessing racial harassment and victimisation at work can make a complaint to their employer.

According to the Advisory, Conciliation and Arbitration Service (ACAS), employers are required to:

  • Take complaints very seriously
  • Handle them fairly and sensitively
  • Keep the complaint as confidential as possible.

ACAS says it is best to make a complaint as soon as possible, but even if you make a complaint a long time after an incident took place, your employer should still take it seriously. Racism has no place in today’s society and no one should face it – particularly when offering a service to the public.

The customer is not always right

When handing such situations, Elsy Gomez Campos, president of the UK Black Pharmacist Association suggests the following: 

  • Always keep calm and professional. Regardless of the customer’s hostility, responding with anger is not the answer
  • Do not try to deflect the encounter by laughing it off or ignoring it. Racism is not a laughing matter and should never be overlooked
  • Make it clear that racial discrimination is not tolerated. Have a prepared statement that includes denial of service if necessary
  • Have an anti-racist protocol to guide employees’ actions. Knowing that employers are supportive can go a long way in encouraging staff to help those who experience racism at work
  • If there is imminent danger, remove yourself from the situation and seek help
  • Always keep records of the encounter. Real-life incidents can inform the implementation of future supportive and preventative measures. 

The customer is always right is a thought at the back of the mind of public-facing staff. However, when the customer is racist, he or she is always wrong and doesn’t deserve the service on offer.

Don’t forget union and regulator support

Sima Hassan, MPharm associate programme director and lecturer in pharmacy practice at Aston School of Pharmacy, and president of the PDA BAME Pharmacists Network, says racism comes in many shapes and forms.

She takes a step-by-step approach:

Step 1: Consider GPhC/PSNI standards and guidance, and prioritise providing safe and effective care and services to the patient. Refer to resources available in pharmacy that can be consulted to tackle racist behaviour.

Step 2: Explain to the patient that the way they are behaving is inappropriate and unacceptable, and that you are considering reporting the incident to the patient’s GP/key worker. If there is an imminent threat to you or staff, then contact security or the police.

Step 3: Explain to the patient that if their behaviour continues, you may not be able to continue to provide a service for them. Consider providing them with alternative options, such as other accessible pharmacies.

Step 4: Bring the incident to the attention of your employer, as they must also take responsibility for the safe working environment for their employees.

Step 5: Document the issue and discuss it with your team. This is a good opportunity to consider how to better tackle such situations and refer to appropriate resources and training materials.

Step 6: If your employer does not seem to take any action as a result of the issues raised, then consider contacting your union (the PDA for pharmacists) and/or GPhC/PSNI as the regulating body.

As a practising BAME pharmacist I have lived experiences of racism. Racism can be both explicit and implicit, with the latter much more difficult to deal with.

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