The NHS was designed to provide treatment at the point of need. So why are BAME communities still struggling to access the care they need?
Writer: Zara Ahmed
Editor: Pauline Münchenberg
Artist: Cveta Gotovats
An old, South Asian woman walks into a hospital and starts exaggerating her symptoms. Put this way it sounds like the start of a poor joke. But some doctors would have you believe this is a perfectly plausible situation that goes by the name of Mrs Bibi (or Begum) Syndrome.
This long-standing medical stereotype, derived from Begum and Bibi being common surnames of Pakistani and Bangladeshi women, depicts elderly, ethnic women as ones who dramatise their health complaints. Aside from the obvious racial insensitivities, it serves to alienate other patients from ethnic minorities. They may delay seeking treatment as they believe their conditions will not be taken seriously and to avoid being diagnosed with ‘Bibi-itis’.
Healthcare inequalities are the differences in care received by different groups of patients. Experiences using the NHS, access to treatment and social factors all contribute towards establishing a person’s health status. It is no secret that Black, Asian and minority ethnic (BAME) patients in the UK suffer from poorer health than their White counterparts in many different areas. They are more likely to suffer from underlying health conditions such as high blood pressure and diabetes. South Asian women have a higher risk of suicide and Black women are almost twice as likely to have a stillbirth and five times more likely to die in pregnancy. The idea that doctors and other health professionals may be widening the gap to healthcare equality with their own bias and microaggressions is even more disconcerting. A study found that Asian dementia patients are 14% less likely to be prescribed anti-dementia drugs than White patients, with researchers suggesting this may be due to “language and cultural barriers”.
Medical education in this country is at the heart of the issue. Although the process of increasing BAME representation in patient case studies, clinical images and textbooks is well under way, the fact remains that generations of doctors were educated in a system that did not represent the population demographics they are now working with. And of course, with medical students shadowing doctors, watching and learning all the time, they may pick up unhelpful colloquialisms in the clinics. One such example was a doctor who said she first heard the term ‘Mrs Bibi’ being used as a medical student. Ten years later, as a foundation year doctor, the term was used by her colleague to diagnose a patient who was due to be seen in the Emergency Department. The colleague went as far as to call the patient’s surname “the crucial diagnostic clue”.
Unwelcome is the thought that this problem may be set to expand further. Despite the perpetual talk of an artificial intelligence (AI) revolution in medicine being on the horizon, it may not be as ready for rollout as we think. These innovations are designed to improve diagnoses, treatment and patient experiences. Yet in 2016, only 19% of patients in AI healthcare trials were of non-European ancestry. If AI is the future of medicine as we are being led to believe, then what confidence can BAME patients have in a system that simply was not designed for their use?
Racial inequality in healthcare has been around for a long time, but fortunately conversation about these disparities at a national scale has certainly increased due to the COVID-19 pandemic. BAME communities were hit disproportionately hard by the virus. Men and women of Black ethnicity, after adjusting for age, have the highest risk of dying from COVID-19. They are four times as likely to die than people of White ethnicity. Furthermore, data released by the Office for National Statistics show that 34% of admissions to intensive care due to the virus were patients of ethnic minorities, despite accounting for only 13% of the population of England and Wales.
BAME patients, particularly the elderly or those with limited English proficiency, on the already-difficult road to recovery, should not have to be extra vigilant in trying to navigate the murky waters of healthcare. Everyone should be guaranteed to receive the treatment and advice suitable for their condition, regardless of skin tone, ethnic background or surname.
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