By Azzy Elmubarak
It’s safe to describe the British perception of doctors as a manifestation of virtue: unsullied, tireless devotion to NHS values of respect and compassion for everyone who needs it.
As a British medical student approaching my final year of study, I would comfortably agree that these sentiments are integrated near-enough successfully into my learning. Like many of us, I have witnessed countless examples of healthcare professionals whose generosity influences their every action. I truly believe you will meet the most incredibly kind individuals working in the NHS.
Unfortunately, I’ve found it increasingly difficult to ignore the distinct hum of classist prejudice among doctors and medical students. Please note that I am careful to attribute this experience to doctors and medical students, only. My anecdotal experiences have exclusively occurred in spaces that aren’t occupied by nursing staff or allied healthcare professionals: a sort of ‘locker-room talk’ for medics, perhaps.
The medical school I attend incorporates GP surgery placements from the first year of study. It’s a wonderful opportunity to get small-group tutoring with a consistent mentor, each year. From my own experience, it’s commonplace for your GP tutor to begin the relationship by introducing you to how their practice runs, the staff and the demographic of the area it serves. The introductions I’ve received tend to go a little like this:
“We’re lucky here, it’s a really nice area, so the patients are lovely. Mostly middle class and white. They have their quirks, a few anti-vaxxers here and there, but overall- a pleasure”.
I must be clear that I appreciate the importance of patient demographics when it comes to healthcare. A younger population may have more sexual health needs, while a large first-generation immigrant population may necessitate easily accessible translators. Similarly, populations with many manual workers may have higher incidences of musculoskeletal issues. My real complaint lies with the repeated attribution of virtuous traits to those of a higher socio-economic class. In contrast, the vernacular I’ve heard muttered about the working-class patient population includes synonyms for “difficult”, “impossible” and “futile”.
My millennial/Gen Z-ish generation receives plenty of criticism for being too ‘woke’ for our own good, so it may surprise some to realise how often I’ve heard peers echo this classist rhetoric as they now approach graduation. Conversely, it’s entirely unsurprising when we acknowledge that most medical students (myself included), attended independent or grammar schools.
During medical school, we are reminded to cherish each member of the public who permits a medical student to hone their clinical skills with them. The generosity of individuals stuns me each time I’m enthusiastically welcomed to make someone’s stressful day at The Doctor’s even more tedious. So, when a senior clinician sucks their teeth and winces “oof, BAME central...” upon hearing the name of a hospital serving working-class ethnic minorities, you’ll understand why I feel revolted.
I’m a firm believer that the vocabulary we use influences the way we perceive our environment, and vice versa. I find language that perpetuates an ‘us and them’ attitude forbids any desire to circumvent healthcare barriers faced by the majority of the British population. By calling certain patients ‘a pleasure’ and others ‘hopeless’ we actively encourage the cheating of those who work hardest in our society. They are denied the compassionate, personalised healthcare we claim to give them, as achieving this is characterised as a mystifying impossibility for doctors who believe they are too ‘refined’ to relate. The result is a patronising, paternalistic outlook.
Change is all-too slow to ensure the socio-economic background of British doctors mirrors that of the nation they treat. We cannot continue to ignore the insidious pomposity of the medical field.