North Shore Hospital Patient’s Request to Avoid Asian Staff: We Cannot Tolerate Racial Bigotry in Our Healthcare System – Dr. Nina Su

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As healthcare professionals, we are increasingly encouraged to practice patient-centered care – a compassionate approach in which we treat each person as an individual with their own needs and abilities, and do our best to meet their unique care preferences. However, this raises an important question: what are the limitations of this care?

In the case of the Pākehā North Shore patient who refused to involve Asian personnel in his surgical care, I was shocked that this request was granted.

At a time when we collectively reject racism, consider ourselves wiser than our backward ancestors, and try to embody cultural safety, how could hospital management fail to respond appropriately when faced with explicit racism?

I was born in New Zealand to working-class Chinese immigrant parents, grew up in Warkworth, studied hard and became a pediatric emergency doctor. On any given day, up to half of my medical and nursing colleagues are of Asian descent.

It would be ridiculous for any of our patients to refuse to be cared for by an Asian staff member. We are highly qualified, speak perfect English and have lived and trained in New Zealand for years.

Growing up in a small Pākehā-dominated town, strangers and classmates often reminded me of the color of my skin and especially the shape of my eyes.

However, as I reached adulthood and moved to the city, I felt things were getting better. In the 2010s I began to feel that my culture, my existence, my history were accepted.

I noticed that people no longer shouted racial slurs at me on a walk or told me to “go home.” We were becoming a country of increasing tolerance and appreciation of difference. However, I am now concerned that recent efforts to spread tolerance and dispel racism are having the opposite effect.

IIn my medical training, I participated in several workshops on cultural safety and implicit bias formation, part of a movement commonly called DEI (Diversity, Equity and Inclusion).

They vary in quality and points of emphasis. The courses I found most helpful included basic training in tīkanga, which emphasized that everyone has implicit biases.

They showed us that prejudice peaks when we are stressed and overwhelmed, running on autopilot. Most importantly, they taught mindfulness skills to remember that the person in front of us is an individual, unique to the demographic they belong to.

Compare this to many other workshops where facilitators seemed to want to make participants feel guilty about “white privilege” or “white fragility” and heavily emphasized ideas of anti-racism and decolonization.

It is worth noting here that I consider it important to critically examine the negative consequences of colonization and its downstream effects on the socioeconomic and health outcomes of indigenous peoples.

The evidence of worse health outcomes for Māori and Pasifika is glaringly obvious; I see this every day in my work. My concern, however, is that by labeling all health disparities as a result of systemic racism, we risk increasing racism while ignoring the more significant problem of intergenerational poverty.

I question whether the DEI framework actually achieves more diversity, equity and inclusion.

Most research on DEI initiatives relies on the power of the Implicit Association Test (IAT), uncovering implicit bias and showing that diversity training lowers people’s test scores. The problem is that taking a single IAT has never been shown to truly translate into an individual’s actual behavior toward others.

Even worse is that your IAT score varies significantly based on the time of day, how tired you are, or just random variation. I have yet to find research that actually measures changes in workplace culture and performance after DEI training.

More worryingly, there is evidence to suggest that mandatory training can increase discrimination when people are made to feel shame or guilt about their own immutable, often “white” characteristics.

This then raises the question: can we justify spending hundreds of thousands of taxpayer dollars on these courses for all of our public employees if there is no known benefit and, in some cases, harm?

In a public service like Te Whatu Ora-Health New Zealand, managers are more likely to receive mandatory training in diversity, equity and inclusion. So why, when presented with a textbook example of racism, did management respond by perpetuating it to its own employees?

At best, these management decisions were made out of compassion for the patient and protectionism toward our Asian staff. But this is not compassion. This is paternalistic, condescending and, at worst, a violation of basic human rights by an employer who prohibits his employees from performing their jobs solely on the basis of their race. Even more worrying are allegations that people were prevented from speaking out.

This sets a dangerous precedent.

Perhaps most enlightening was the response from New Zealand’s most vociferous experts on social justice. Despite increasing reports of hate crimes and violence against Asian people, the silence has been deafening from our staunchest supporters of the DEI social justice framework.

We must remember our core values. Our compassion must not extend to racism and we cannot tolerate intolerance.

*This opinion is my own and does not reflect Te Whatu Ora-Health New Zealand.