Racism in medical practice

• Racism encompasses acts or behaviours that discriminate against individuals based on their race, colour or ethnic origin including verbal abuse, harassment and discriminatory practices.
• It is important to identify and respond to racist or antisocial behaviour which could contribute to a culturally unsafe workplace.
• Doctors and workplaces both have obligations to provide a culturally safe environment for colleagues and patients alike. It is important to speak up against racism and support colleagues who experience discrimination or abuse.

Racism not only impacts patient care but also workplace dynamics and culture. Understanding the legal framework and your obligations and identifying instances of racism are important steps in developing a culturally safe environment for healthcare staff and patients.

This factsheet outlines the legal framework that applies to racist behaviour, your obligations as a doctor to provide culturally safe care, and your rights to a culturally safe workplace. It outlines how to identify racist and antisocial behaviour and provides some practical advice on how to address racism in the workplace. 

Racial discrimination and racial hatred are governed by both federal and state/territory legislation. Under this legislation, racism encompasses any act or behaviour that discriminates against individuals or groups based on their race, colour or ethnic origin. This includes actions such as:

• verbal abuse
• harassment
• discrimination in employment or services
• racially offensive behaviour that causes harm or distress.

Racial Discrimination Act 1975

The Racial Discrimination Act 1975 is the main federal legislation addressing racial discrimination and racial hatred in Australia.  The Act makes it unlawful to commit an act that is reasonably likely to offend, humiliate or intimidate a person or group because of their race. Examples include:

• racially offensive material on the internet
  • A doctor posts racially derogatory comments about work colleagues of a particular ethnic background on a public forum or social media platform.
• racially offensive comments or images in a newspaper
  • A medical practice places an advertisement in a local newspaper containing discriminatory language or imagery implying a preference for doctors of a certain race or nationality.
• racially offensive comments in a public place
  • A hospital staff member makes a derogatory remark about other staff members of a specific racial or ethnic group within the hospital premises, creating an intimidating or hostile environment.
• racially offensive speeches at a public rally
  • A doctor delivers a public speak at a medical conference or seminar where they express racially discriminatory views or advocate for medical practices that disproportionately disadvantages patients of a certain racial or ethnic background.

The Act does however, protect freedom of expression that relates to public discussion, artistic work, fair comment and reporting, provided it is done reasonably and in good faith.

State and territory laws

Each state and territory has its own laws regarding racial discrimination and racial hatred. Generally, these laws complement the federal legislation or offer additional protections.  State and territory specific anti-discrimination commissions or tribunals are often tasked with handling complaints related to racial discrimination at a local level.

Recognising racism and distinguishing it from antisocial behaviour is important as there are specific racial discrimination laws which provide individuals with legal recourse if breached. Below are some ways to identify racism, along with some examples of behaviours that may be antisocial but not necessarily racist under the legal definition.

Racism

Discriminatory treatment

Be alert to instances where patients or colleagues are treated unfairly based on their race, colour, or ethnic origin. This may include differential access to healthcare services, biased decision-making, or unequal treatment in clinical settings.

Verbal abuse or harassment

Pay attention to any derogatory language, racial slurs, or offensive remarks directed at patients or staff members because of their race. Such verbal abuse or harassment contributes to a hostile and discriminatory environment.

Racial profiling

Watch for instances where patients are stereotyped, stigmatised, or subjected to heightened scrutiny based solely on their racial or ethnic background, rather than on individual characteristics or clinical need.

Cultural insensitivity

Notice attitudes or behaviours that demonstrate a lack of cultural awareness or respect for diverse backgrounds. This may include dismissing or disregarding cultural practices, beliefs, or preferences of patients or colleagues.

Understanding antisocial behaviour (not necessarily racist)

General rudeness of incivility

Instances of rudeness, impoliteness, or incivility towards patients or colleagues may constitute antisocial behaviour but may not necessarily be driven by racial prejudice. It's important to address such behaviours regardless of their underlying motivations.

Conflict or Disagreement

Conflicts or disagreements among individuals in a medical practice may arise due to various factors unrelated to race, such as differences in opinion, communication styles, or personality clashes. While these conflicts should be resolved promptly, they may not always involve racism.

Professional Disputes

Disputes or disagreements related to clinical decisions, professional conduct, or organisational policies should be addressed through appropriate channels within the medical practice or healthcare organisation. While these disputes may lead to tensions, they may not necessarily be rooted in racial discrimination.

Miscommunication or misunderstanding

Miscommunication or misunderstandings between individuals from different cultural backgrounds may occur without any malicious intent. It's essential to foster open dialogue, cultural sensitivity, and effective communication to prevent misunderstandings from escalating into racial tensions.

By understanding the nuances of racism and antisocial behaviour, doctors and medical practices can effectively identify and address instances of discrimination while promoting a culture of respect, inclusivity, and equity in healthcare delivery.

Doctors have a professional obligation to provide culturally safe and respectful care to all patients.

The Medical Board of Australia has provided additional guidance on cultural safety in Good Medical Practice: A code of conduct for doctors in Australia (the code of conduct). Good medical practice includes (4.7, 4.8):

• being aware of your own cultural assumptions, values and beliefs and how these may influence your interactions with patients
• respecting cultural differences
• avoiding bias, discrimination and racism.

The Medical Board also recognises that culture and history has negatively influenced the health and treatment of Aboriginal and Torres Strait Islander patients. Doctors are also expected to be sensitive to this issue.

Doctors have a professional duty to provide culturally safe care to all patients, irrespective of their racial or ethnic background. This involves acknowledging and respecting cultural differences, ensuring equitable access to healthcare services, and addressing any instances of racism within the medical practice or healthcare organisation.

Doctors have the right to work in a culturally safe environment free from discrimination and harassment. Medical practices and healthcare organisation should promote diversity, inclusivity, and respect for all staff members, fostering a supportive workplace culture.

Employers must ensure that workplaces are free from discrimination and racial hatred. Work health and safety legislation now requires employers to take a proactive and consultative approach to protecting workers against these risks. See our factsheet on Psychosocial hazards

Those experiencing racism may not feel safe or confident to speak up. Changing behaviours also requires organisations and individuals to take action in support of patients and colleagues.

You have several options available to you if you experience racism in the workplace:

• You can choose to do nothing. For many reasons, including your wellbeing, the choice to step away may be the right one for you.
• You can speak to the person directly, either immediately or if you need time to think and regroup you can address it at a later time. This may work best in an informal way such as over a coffee and explain how the comments or actions made you feel.
• You can ask a colleague to speak to the person on your behalf. This may be an appropriate response if there is a significant power imbalance between you and the person.
• You can take a more formal approach through your hospital or practice’s grievance processes.

In any professional setting, fostering an environment of inclusivity and respect is paramount. However, when faced with instances of racism and antisocial behaviour, it's essential to take proactive steps to address and combat such behaviour. Here are practical tips to empower you in confronting racism and promoting a culture of diversity and equity in your workplace:

• Asking for clarification can be helpful – ‘What makes you say that?’, ‘Can you tell me why you think that?’
• Sometimes humour can work – for example when someone compliments a second-generation Australian academic on his excellent English, he returns the compliment: ‘thank you, so do you.’
• Correcting an error – if when someone assumes your Asian female colleague is a nurse, introduce her with her title.
• Creating space for a colleague if they are being interrupted – ‘I think X made a good point – can you repeat it?’.
• Provide a counter-narrative – ‘That’s not my experience’.
• Speak up yourself – say that you don’t find the comments funny and you would like them to stop.
• Physically align yourself with a colleague who has experienced racist behaviour and check if they are ok.

Be mindful of your own language, actions, and decisions to ensure they do not perpetuate racial stereotypes or discriminate against patients or colleagues. Embracing cultural humility, actively listening to patient perspectives, and seeking to understand diverse backgrounds are essential in providing equitable healthcare.

If you experience racism yourself or vicariously through patients and community, it can have a damaging effect.

It is almost always counter-productive to act out of anger.

If you are able to address discriminatory incidents immediately and safely you should do so. However, if you feel you are unable to say something at the time, it may be better to address the behaviour with the speaker at a later time.

Do not feel that you have to ‘fix’ the racist behaviour or respond to every comment.

Speak to supportive colleagues, organisations or Avant. In particular the Cultural Liaison Officers available in most health services can be a valuable resource.

For medico-legal advice, please contact us on nca@avant.org.au or call 1800 128 268, 24/7 in emergencies.