Dealing with racist abuse

RACIST abuse directed at dental staff by patients remains a serious problem. Dentists and dental teams take great care to ensure that patients are treated fairly. That makes it all the more painful when they are on the receiving end of such abuse.

Mainstream media reports regarding racist abuse directed at healthcare professionals tend to focus on NHS staff in general without specifically recognising the similar issues faced by dentists and their teams. A recent ITV report featured a moving interview with senior surgeon Mr Radhakrishna Shanbhag, who has worked in the NHS for more than 20 years. He described how one of the patients on his waiting list requested a “white” doctor carry out his operation, and how this gave him cause to reconsider his position in the NHS.

The report sparked much debate, with some taking the view that adhering to such requests is the easiest solution, despite believing it only rewards bad behaviour. Are you expected to carry on treating a patient despite feeling abused and threatened? Can you refuse to treat such patients? What if there is no alternative dentist available or if it relates to your receptionist and you only have one?

It’s important to remember that there are a range of potential appropriate responses, dependent on the specific issue and the context. For example, you may have a patient who appears to be reasonable and non-threatening but still asks for an “English-speaking” or “non-foreign” dentist. Such a request may not require an immediate reaction from you and perhaps finding an opportunity to highlight how the patient’s behaviour is inappropriate will be enough to make them think again.

Any formal steps taken to warn a patient in regard to such comments should be communicated by letter. Should such behaviour persist you can then escalate matters and potentially refuse treatment.

Situations where a patient is demonstrating clear abusive and threatening racist language or behaviour should not be tolerated. Such behaviour may understandably result in a breakdown of trust between you and the patient, therefore compromising your professional relationship with them. Our advice would always be to keep yourself safe – and if at any point you feel threatened take appropriate steps. In extreme circumstances, this may even include calling for police assistance.

The GDC’s Standards for the dental team offers guidance on ending your professional relationship with a patient (paragraph 1.7.8).

It states: “Before you end a professional relationship with a patient, you must be satisfied that your decision is fair and you must be able to justify your decision. You should write to the patient to tell them your decision and your reasons for it. You should take steps to ensure that arrangements are made promptly for the continuing care of the patient.”

In delivering care, where any delay could result in undue harm to a patient, MDDUS advises that you prioritise urgent care needs first before taking any action.

Your organisation or practice should have a policy in place which sets out its expectations of patient behaviour towards staff. It should highlight that any kind of racial abuse towards staff is unacceptable, and within this policy there should be clear guidance on how these situations will be handled. Employers are required, under the Equality Act 2010, to protect their staff from discrimination relating to age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage/civil partnership and pregnancy/ maternity.

ACTION POINTS

• Avoid reacting out of anger or upset and take time to assess the situation before taking action.
• Consider whether a warning to the patient would be deemed enough to deter them from further abusive behaviour.
• Should you or a colleague feel threatened, you may need to take immediate action, such as phoning the police and having the patient (or family member/carer) removed from the premises.
• For employers, ensure you are complying with the Equality Act 2010 and have clear policies and procedures in place that protect your staff from abuse of any kind.

Kay Louise Grant is a risk adviser at MDDUS