A doctor like me
The London School of Medicine for Women, the first medical school in the UK to train female doctors
Source: Wikimedia Commons
Tharani Ahillan discusses the importance of diversity in the medical profession.
“When I get ashamed of my hallucinations,” one patient told me, “my counsellor told me that doctors can go through it too. Just like I might be pregnant, so too would the doctor. That really they’re not so different from us. It made it much easier for me to open up to my doctors.”
This statement stuck with me in my psychiatric placement as a warning of the damage that an appearance of the medical profession being “privileged” could do to doctor-patient relationships. As medical students, we are taught to empower the patient — that they are the most important driver in their healthcare. But as Emma Darko, a UCL fifth year medical student, explains, “Britain is known worldwide for being a melting pot of diversity … it's important that healthcare providers are a reflection of the diversity of the patients that we treat and build on that trust.”
In 2012, Alan Milburn, the then-government’s reviewer of social mobility, accused the medical profession of “failing to make any great galvanising effort” to open doors to poorer students. Fast forward seven years and the article in the Daily Mail — “we have too many posh doctors” — highlights that the movement in Medicine away from the stereotypical white, privileged, male doctor is far from over.
The British Medical Journal recently highlighted that UK universities currently spend £800 million to widen participation in under-represented students, from the inclusion of an additional foundation year to lower academic entry requirements. Yet is this enough?
Ethnic Minorities in Medicine
The representation of ethnic minorities in Medicine certainly seems to be a great success story. Two-fifths of new medical students in 2016 were of black or other minority ethnic backgrounds, compared to a quarter in higher education overall. Despite this, Bangladesh and black Caribbean students remain under-represented.
Dr Amali Lokugamage, who helped found the Decolonising the Medical Curriculum project at UCL Medical school, believes action needs to be taken beyond just recruitment into medical school. Writing in the British Medical Journal in conjunction with Dr Faye Gishen, she said that “Medicine and medical education could, on some levels, be accused of ‘colonising’ students, patients and doctors … our goal is to enable students from minority groups to feel less marginalised by traditionally white, male, euro-centric content.”
The inspiration to do so comes from examples that patients from ethnic minorities might be neglected as part of the existing curriculum. For example, students are not taught practically to detect clinical signs such as anaemia and cyanosis in BAME patients. The effects on patients can be devastating: one study found an average five-year melanoma survival rate of only 65 percent in black people, versus 91 percent in white people. Indeed, at medical school we are now taught that some bedside tests need to be adapted based upon the background of the patient. By propelling this academic movement onward, Gishen and Lokugamage hope to “highlight inequalities resulting from historical colonial influences and to transform and modernise materials.”
Women in Medicine
Women entering the London School of Medicine for Women in 1877 — the first medical school in the UK to train female doctors and one of the predecessors of UCL Medical School — would have been proud to hear that almost 150 years later women represented 47% of the medical workforce in 2015, with female medical students now outnumbering males.
It’s easy to see why this is so pivotal: the gender bias in medicine was reported in the Journal of Women’s Health in 2008. It outlined how a variety of conditions such as coronary artery disease, Parkinson’s and even tuberculosis was investigated and treated more extensively in men than women with the same severity of symptoms. Perhaps more worryingly, older women were less likely to be admitted to intensive care units or receive life-saving interventions. Awareness of the custom of performing clinical trials exclusively on young or middle-aged white men led the influential National Institute of Health in the USA to issue guidelines in the 1990s requiring that women were included in all its sponsored clinical research. A 2015 study demonstrated the impact that involving female scientists in projects has: the more involved women were in the creation and execution of a study, the more that study accounted for “gender related and sex-related factors.”
With numerous international studies showing that female doctors provide more patient-centred care, and make up just 25% of complaints escalated to the UK governing body, the General Medical Council, it suggests that improving the quality of healthcare in the UK is linked with encouraging women to both enter and thrive in medicine, for the benefit of patients of all genders.
Disability in Medicine
The General Medical Council, the UK governing board for doctors, makes it clear that disabled people should be welcomed to the profession.
As if proof was needed, Alexandra Adams is set to become the first deaf-blind doctor in the UK. Speaking to the Daily Mail, she said that her cane “lets [patients] see their doctor is human … doctors aren’t superheroes and I don’t think they should try to be.”
Perhaps this attitude is what would improve the morbidity and mortality in the UK among disabled people. This is a particularly stark issue for those with learning disabilities: the proportion of people with learning disabilities who died in hospital was greater (64%) than the proportion of hospital deaths in the general population (47%). Raising awareness about the health issues accounting for this high mortality rate to allow for their prevention, identification and early treatment, as well as a coordinator for those with learning disabilities, could be the key to lowering this figure. But one of the most important steps is mandatory training for healthcare staff working with people with learning disabilities — and creating diversity within the workforce to help teach others, can be the start of this.
Social Class in Medicine
This leads us onto the elephant in the room, an issue that has recently re-entered the public sphere — class. A 2016 report by the British Medical Association revealed that just 4% of doctors come from a working class background.
The #mypathtomedicine hashtag on Twitter in 2018 highlighted just how unusual it can be, celebrating the diversity that comes with attracting people from a wide variety of backgrounds. One use @Jingstar put up two photos: one in 2007 when he was about to get kicked out of school, and another when he was MedSoc President. He said “I knew I wanted to be a doctor but didn’t know how, so I bought a 50m WiFi dongle and used unprotected WiFi on my estate to learn more about the career”.
The head of Sunderland Medical School, launched in 2019, spoke to the Guardian about the reasons to attract such people: “Doctors coming from these backgrounds … have a far better understanding of the social factors that are prevalent in the areas they come from.” It is also common for doctors to stay in the area that they are trained, and an increased retainment rate in the North may help reduce the North-South divide of health-related disparities in the UK, where Northerners among 25-44 year olds are 47% more likely to die from cardiovascular complications, 109% from alcohol misuse and 60% from drug misuse compared to their Southern counterparts.
Tanvi Khetan, a fifth year medical student at UCL, explained that this is equally vital in London: “because the cost of living here is so high, it is important to help promote social mobility within medicine. I think there has been a lot of progress but there is still room for improvement, particularly with making financial aid more accessible.”
Not only is diversity vital for patient outcomes — in an era where staff morale in the NHS is low, and more than half of UK doctors have considered quitting the NHS or cutting their hours in the hope of an easier life — appealing to a wide range of people right from recruitment into medical school may be part of the answer.