Una Coales: How to kick the bias out of medicine

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The Independent Online

Last week The Independent, i's sister paper, published a front page report headlined "Senior GP tells doctors to act less gay". It related to my advice book for doctors on how to pass their Clinical Skills Assessment (CSA) examination interviews. Brief extracts may look controversial, but when viewed in context they become sensible and necessary pieces of advice.

When I applied for a job in 1994, I was asked: "Who is the Captain of the England rugby team?" and "How would you feel as a mother leaving your child at home?" I was unsuccessful. In 1996, I finally got a job at the same hospital. The white male surgeon interviewers were that time thoroughly professional. Having difficulty advancing my career, I asked a renowned surgeon to look over my CV. At his suggestion I deleted my maiden name, "Choi", and the interviews started coming.

For me, discrimination in medicine was stomach-churning. Gay people had the added agony of deciding whether to be discreet (or even lie) about their sexuality. In the early 1990s I had worked in a highly diverse (ethnically and sexually) hospital in New York. The trauma surgery team I belonged to had, at one point, been all female. Our patients too were multicultural and open about their sexual orientation.

The greatest barrier to racial and sexual equality is institutional denial. Working in NHS hospitals, I learned the phrase "be a grey man" which means don't cause waves, don't stand out, don't speak up, turn a blind eye, and keep your head low. The consequence of talking about racism, discrimination or selective social engineering was career suicide. When I was first elected to the Council of the Royal College of GPs, I was given similar advice. How strange to be working in such a hostile environment coming from America, where efforts on behalf of minorities were encouraged and there was zero tolerance of racism and discrimination.

In 2001 a Kings Fund report, Racism in Medicine, found that bullying and discrimination were a fact of life for black and Asian doctors. A BMA survey two years later revealed that among ethnic minority doctors, who form nearly a third of the NHS workforce, more than 80 per cent believed their ethnicity had hindered their career advancement.

In 2009 I published a series of articles offering CSA exam revision tips in a medical magazine, and then reprinted the same advice for GPs in a book. Shortly after its initial publication, an RCGP internal study identified the need for enhanced diversity training for examiners. This has been implemented and the College continues to make great efforts to minimise bias. Overt bias has been eliminated from its exams but there is still a risk of subconscious bias. My exam book advises doctors on how to avoid anything in their behaviour likely to distract from a pure appreciation of their medical skills. I am blunt, as many doctors may be in denial about cultural (mis)perceptions. I respect that some feel that to compromise one's identity is wrong. I make no judgements. My advice has helped hundreds of doctors pass their exams by reducing bias and placing them on an equal footing.