Complacent About Discrimination”
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this week RONALDO AND COKE page 465 • RECOVERY TRIAL page 466 • EARLY RETIREMENT page 468 MARK THOMAS GMC “complacent about discrimination” An employment tribunal has ruled for and discrimination at Heatherwood and The GMC (above) is accused the fi rst time that the GMC discriminated Wexham Park Trust, now Frimley Health of failing to take racial against a doctor on the grounds of race. Trust. The trust accused him of bullying and discrimination into account Omer Karim, a consultant urologist threatening behaviour towards a colleague. when dealing with the case against Omer Karim (inset) referred to the GMC by his employers, was The trust referred him to the GMC in treated diff erently from a white doctor who 2014. The next year interim conditions was also under investigation, the Reading were placed on his practice, pending a employment tribunal held, and there was full investigation. These were lifted later no credible explanation for the diff erence. that year, but it took three more years for a The way the GMC dealt with some of the hearing to clear him of any misconduct. allegations suggested that the regulator was The tribunal heard that although black “looking for material to support allegations and other ethnic minority doctors made up LATEST ONLINE . rather than fairly assessing matters 29% of UK doctors they were the subject of presented,” the tribunal noted. 42% of employers’ complaints. UK graduate GP is liable only The tribunal said it was “concerned doctors from ethnic minorities were 50% for costs of harm related to her there was a level of complacency about the more likely to get a sanction or warning than advice in case of operation of discrimination in the work of their white peers. “wrongful birth,” GMC or that there might be discrimination Karim accused the GMC of a “callous say Supreme infecting the referral process.” It noted disregard for the truth and honesty.” He Court judges “the failure of all the witnesses to express added, “Right from the outset, the GMC saw Trieste’s mental how, if at all, the awareness of the over- me as a guilty black doctor. We doctors need healthcare model representation of [black and ethnic to work to change the system.” is under threat, minority] doctors in complaints to the GMC A GMC spokesperson said, “We are giving claim supporters was considered in the investigation process full consideration to the fi ndings.” of the community or whether discrimination may have been a Frimley trust said in a statement, “We based approach factor consciously or unconsciously in the want to be the best possible employer and Hancock comes allegations faced by the claimant.” we will continue doing everything we can to under renewed The tribunal heard that Karim, a specialist listen to staff and eliminate inequalities.” pressure from PM’s in prostate cancer and robotic surgery, Clare Dyer , The BMJ former chief aide blew the whistle on poor practice, bullying, Cite this as: BMJ 2021;373:n1595 the bmj | 26 June 2021 463 SEVEN DAYS IN Eight in 10 doctors experienced moral distress during pandemic, BMA survey fi nds Four fi ft hs of nearly 2000 doctors who responded to a BMA survey said the term “moral distress” resonated with their experiences of working during the pandemic, and over half said the same for “moral injury.” The BMA defi ned moral distress as the “psychological unease generated where professionals identify an ethically correct action to take but are constrained in their ability to take that action.” Moral injury, the BMA said, can arise where sustained moral distress leads to impaired function or longer term psychological harm. “Moral injury can produce profound guilt and shame, and in some cases also a sense of betrayal, anger, and profound ‘moral disorientation,’” it explained. Helen Fidler, deputy chair of the BMA’s Consultants Committee, said what was important was “being able to now name the struggles that many doctors are having and pinpoint exactly what needs to be done to alleviate them.” The BMA has called for extra investment in the NHS, better staffi ng, and emotional and psychological support for healthcare workers. Abi Rimmer , The BMJ Cite this as: BMJ 2021;373:n1543 Covid-19 Chaand Nagpaul, chair of BMA pharmacological interventions for a new members’ bill that Health secretary ordered council, said that compulsory such as ketamine as justification seeks to change the law on to disclose documents vaccination of healthcare staff for excessive police force, which assisted dying in Scotland, The UK information commissioner raised new ethical and legal is disproportionately cited in paving the way for the first ordered England’s Department implications and that efforts cases where black men die in law debate on prospective of Health and Social Care to should be focused on targeted enforcement custody. legislation in Holyrood for more disclose two briefing papers engagement. Any policy must than five years. Supported by forming part of Exercise Cygnus, avoid discrimination, he said, Assisted dying Dignity in Dying, the bill would which Moosa Qureshi, an NHS given that uptake of the vaccine Hancock wants “holistic” legalise assisted dying as a consultant haematologist, has was lower in some ethnic and informed debate choice for terminally ill, mentally been campaigning for since the minority groups. England’s health secretary, competent adults—a change pandemic started. The papers Matt Hancock, acknowledged supported by 87% of the public cover how the NHS and social care problems with the current law in Scotland. would cope if a major pandemic that prohibits assisted dying as overwhelmed resources. Qureshi well as the risks in changing it. He Prevention said in a blog, “By refusing to told the All Party Parliamentary NHS will offer “health provide a population triage Group for Dying Well, which MOTs” at vaccination sites protocol, both the Department opposes assisted suicide, that The NHS in England plans of Health and NHS England have assisted dying was a matter to offer “health MOTs” at arguably transferred blame—and for parliament to decide. “It is NHS vaccination services, legal liability—from politicians important that any debate that pharmacies, clinics, and other and corporate executives to Excited delirium we have [on assisted dying] is sites. Announcing the plan, NHS NHS healthcare workers who AMA opposes “excited nested in a wider debate about England’s chief operating officer, had already risked their lives on delirium” diagnosis how we support people better Amanda Pritchard, said that the the front line.” The government The American Medical towards the end of their lives,” aim was to make “every contact has 28 days to respond to the Association adopted a policy said Hancock. He pledged to help count” by rolling out tests such request. to oppose “excited delirium” improve the evidence base and as blood pressure, heart rhythm, as a medical diagnosis and accepted that palliative care and cholesterol checks when Mandatory vaccination to warn against using certain services needed further patients already have other could extend to NHS pharmacological interventions investment. appointments. Checks Staff in England’s care solely for a law enforcement will be offered when homes will be required to be purpose without a legitimate Bill is introduced in patients attend for top-up vaccinated against SARS-CoV-2 medical reason. It said that the Scottish parliament covid vaccinations or flu from October if legislation is new policy, adopted at the AMA’s Liam McArthur (right), vaccinations this autumn approved by parliament, and special meeting of its House of MSP for Orkney, lodged in locations such as village the government is set to consult Delegates, follows reports that proposals in the halls, churches, on whether to extend the showed a pattern of using the Scottish mosques, and local requirement to NHS workers. term “excited delirium” and parliament sports centres. 464 26 June 2021 | the bmj SIXTY SECONDS MEDICINE ON . RONALDO Antibiotics AND COKE Use on UK pig farms has more than doubled HAVE THEY TEAMED UP? Unpublished industry data show Quite the opposite. Cristiano Ronaldo—the that the use of aminoglycosides A steep rise in footballing superstar and global icon—has been widely praised by public health experts on UK pig farms rose from aminoglycoside aft er he shunned Coca-Cola during a press 2.607 mg/PCU (mg per kg of body use in piggeries conference at the UEFA Euro 2020 football weight) to 5.957 mg/PCU from raises fears of championships, where the soft drinks giant 2015 to 2019, raising concerns resistance is an offi cial sponsor. about the effect this could have on rise of antibiotic resistant AWKWARD. IS HE A PEPSI MAN? infections. Agricultural leaders management services, as well as Not as far as we’re aware (although he has have suggested a recent jump in a £30m enhanced service for GPs COVID advertised both brands in the past). But the use of aminoglycosides could to treat patients with long covid. aft er ostentatiously shift ing two bottles be because of the push to reduce DEATHS of Coke away from his vicinity during the other antibiotic use, as well as CPR press conference, the never shy nor retiring the upcoming EU ban on the use NHS offers training Peru ranks top Portugal captain held up a bottle of water before declaring, “Agua!”—encouraging of zinc oxide, which is commonly after footballer’s collapse in the world for people to choose the old H O instead. used to control scour (diarrhoea) The NHS and St John Ambulance deaths per million 2 in piglets. have joined forces to encourage population at TAP OR BOTTLED? people to learn cardiopulmonary He didn’t specify, so we can’t rule out Childbirth resuscitation and how to use 5864, with that he’s a secret agent for “Big Water.” Caesarean sections But given that he’s still in peak physical a defibrillator (below).