Pandering to prejudice

What price patient choice if that choice is motivated by bigotry? Graham Clews investigates

The NHS Constitution, introduced earlier this year, pledges that staff have the right to a working environment ‘free from unlawful discrimination on the basis of race, gender, sexual orientation, disability, age, religion or belief’. But another priority high up the NHS agenda – delivering patient-centred care and increased patient choice – can make the task of tackling discrimination against healthcare professionals more difficult. Gill Cotterill, now physiotherapy inpatient lead at Fairfield General hospital in Bury, Lancashire, was reduced to tears by a patient’s homophobic comments when she worked in the community. In the end the patient’s wife apologised, although the patient did not. ‘It obviously changed the patient relationship but I was the only physiotherapist working in the area at the time so I was in a difficult position.’ Gill Cotterill says homophobia against healthcare professionals has become more subtle in the 27 years since she qualified. During that time an abundance of legislation has given far greater legal protection to the victims of discrimination. But although the laws are in place, discrimination is far from eradicated. A black senior neurological physiotherapist from Zimbabwe, who works at a district general hospital in England, was the subject of a formal complaint from a patient who claimed to be in pain as a result of exercises the physio had prescribed. A subsequent investigation found that the patient had asked the physiotherapist’s colleagues to be treated by a white physio. The complaint was dropped. The physio, who wants to remain anonymous, says: ‘I am the only man on my team and patients sometimes say they would rather be seen by a woman, so you can’t prove that it’s racism.’ So far he and his colleagues have ‘taken the easiest route’, and responded to such requests by simply handing a difficult patient over to another physio. But he and his managers have now agreed to look more closely at why patients request alternative physiotherapists and take action accordingly. Kay Hoare, of the CSP’s lesbian, gay, bisexual and transgender network, says difficulties for gay physios can crop up when patients ask about partners and children. Christo Thiardt, from the CSP’s disability network, says that in 33 years of practising he has only once encountered a patient who asked not to be treated by a blind physiotherapist. And that was more than 20 years ago. ‘I have no doubt that some patients are a bit concerned and wonder how a blind physio will cope, but, if anything, people say “you have a special touch because you’re blind”, which is equally nonsense,’ he says. Natalie Hilliard, who works in the private sector as a neurological physio, says her experience may well be different from NHS colleagues. She has, she says, never experienced any form of discrimination based on the fact that she is gay from any patient. From fellow members of staff, however, it is a different story. ‘I worked with a physio assistant who said I would go to hell,’ she says. ‘But you don’t want to take it forward, although it’s probably illegal, because you don’t want to deal with the stress.’ The CSP rules of professional conduct state that ‘patients do not have the right to select or reject the person who intends to deliver [their] treatment or care on the grounds of prejudice’. However, determining whether or not that selection or rejection is on the grounds of prejudice can prove tricky. The rules recognise that patients might have strong personal or cultural reasons for seeking care from either a male or female physiotherapist, and advise that patients’ views should be taken into account when planning care. But where a therapeutic relationship cannot be established, the CSP advises, the patient, physiotherapist, and possibly a senior colleague, should discuss the situation and the patient should be referred to another physio if possible. Again though, how do you tell when patient prejudice is behind that failure to establish a therapeutic relationship?

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Graham Clews

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