For many doctors across Europe, racist remarks from patients are an unwelcome part of the job. Racial slurs during consultations. Patients making demeaning comparisons with colleagues based on skin color. In theory, institutional policies should protect physicians from this abuse. But many doctors say those policies fall short.

The numbers tell the story. In a 2023 survey by the Medical and Dental Defence Union of Scotland (MDDUS), 58% of international medical graduates responding from across the UK reported experiencing everyday racism at work. However, 72% said they didn’t report these incidents to their institutions because they doubted their complaints would be taken seriously.

“No doctor should have to feel that racist remarks and abuse come with the territory of practicing medicine,” John Holden, MBBS, MPhil, chief medical officer of the MDDUS, told Medscape News Europe. “Racism is not only a personal offense but may also breach equality and criminal law.”

The impact of these interactions can be detrimental to physicians, whether the racism experienced is microaggressive or overt. A review of research by University College London in 2025 found that healthcare providers facing workplace racism can develop symptoms of depression, anxiety, and posttraumatic stress disorder.

When faced with this problem, how should a doctor react? The obvious answer is institutional support. However, standard discrimination policies can be unclear or ineffective when it comes to protecting a physician’s rights, say experts.

The Gap in Institutional Protection

“In many cases, there is no coherent institutional strategy,” Hans Vogt, PhD, a sociologist and research associate at the German Centre for Integration and Migration Research in Berlin, Germany, told Medscape News Europe. “Hierarchical structures, medicine’s self-image of neutrality and objectivity, and the intense workload in both medical training and clinical practice all hinder an honest and critical engagement with these issues.”

Different circumstances also require specific solutions. “Clear institutional policy provides consistency and sets expectations, but it will not anticipate every encounter,” Holden said. “Unfortunately, given the nature of these encounters, there will be times when a doctor feels that a written framework is either insufficient or is not being applied effectively. As set out in the [UK] General Medical Council’s Good Medical Practice, doctors must not discriminate but are also entitled to work in environments that are respectful and safe.”

The correct procedure is more obvious in some scenarios. “If a patient makes a discriminatory request, such as demanding to be seen by a different doctor on racial grounds, that request is clearly not ethically justified,” Holden said. “A doctor is not required to comply simply to avoid discomfort. However, decisions about continuing or transferring care of a patient whose behaviors cause distress and offense must prioritize patient safety and continuity. In urgent cases, a doctor may need to continue to give care. In nonurgent contexts, involving a senior colleague can help determine a proportionate response that does not legitimize discriminatory behavior.”

Addressing the Impacts of Racism

In the MDDUS survey, doctors stated that racist microaggressions caused them stress and lowered their motivation at work, also detracting from their sense of belonging in their job.

“The immediate impact of being racially abused in the workplace can range from humiliation to anger,” Holden said.

Any physician who has experienced an incident of racism should be quickly supported.

“One potential approach is to confront the patient directly as a team, addressing their racist actions or remarks and making it clear that such behavior is unacceptable,” Simon Gerhards, MD, research associate and PhD candidate at the Division of Ethics in Medicine in the Department of Health Services Research at Carl von Ossietzky University of Oldenburg, Oldenburg, Germany, told Medscape News Europe. “This can be especially impactful if the team leader takes a strong stand and communicates a clear anti-racist stance to the patient. The environment within the healthcare team plays a critical role in setting the tone and ensuring a safe and respectful atmosphere for all.”

This kind of intervention can also show a doctor that they are not alone. “Openly acknowledging that the behavior was unacceptable and checking on a colleague’s well-being goes a long way toward restoring the psychological safety of a victim of racism,” Holden said.

Counseling or debriefing can also help if it’s made available to physicians as institutions have a duty of care to ensure a safe environment, Vogt said. “Addressing racism from patients must be understood as an institutional obligation, not as a test of individual resilience,” he added.

What Can Doctors Do if Their Institution Is Not Supportive?

Sometimes, established institutional policy does not go far enough to protect a physician, and they may have to escalate their concern.

In England, doctors can turn to Freedom to Speak Up Guardians — designated staff members in National Health Service (NHS) and independent sector organizations who help workers raise concerns about problems affecting patient care or their ability to do their jobs, including experiences of racism. More than 1200 guardians operate across the healthcare system, supported by the National Guardian’s Office, which was created following a 2015 report that found NHS culture didn’t always encourage staff to speak up about problems.

Doctors can also take proactive steps to improve their work environment, said Nataliya Berbyuk Lindström, PhD, associate professor in communication with a specialization in applied communication technology at the University of Gothenburg, Gothenburg, Sweden. Lindström has published research examining patient bias against migrant doctors in Sweden. The doctors who reported their experiences to Lindström’s team said they dealt with issues such as refusal of care, questioning of language competence, questioning of medical competence, and ethnic jokes regarding stereotypes.

“Yet the physicians in the study were not powerless,” Lindström told Medscape News Europe. “They developed practical ways of handling bias in the moment and in the workplace — even without strong institutional backing.”

These strategies include:

Doubling down on good communication. Many patients equated a foreign accent with lower medical competence. In response, if a doctor summarized information carefully and checked that the patient understood, patients often stopped expressing suspicion toward them. Other doctors offered brief, strategic details about themselves, such as why they moved to Sweden or where they trained, to humanize themselves and build a patient’s trust.

Building allies. Lindström’s research found that nurses can help doctors by “gatekeeping” as they often hear patients’ concerns first. “Supportive nurses can reassure patients, normalize the physician’s competence, and even prepare a doctor in advance for potential tension,” she explained. “During consultations, nurses can help clarify wording or reinforce explanations. That teamwork signals unity and professionalism, which reduces patient bias.”

Create a unified team response. If hospital policy is unclear or lacking, one practical work-around to racism against physicians is creating a micropolicy at the unit level, Lindström suggested. A team can agree on what to say if a patient refuses care based on ethnicity, who will step in if bias escalates, and when to call in a manager. “A shared approach reduces uncertainty and protects individual clinicians from feeling isolated,” she said.

Documenting the issue. Patients may appear polite during an interaction with a doctor but later complain that they weren’t properly informed or didn’t understand the doctor. “Clear documentation of what was explained and how understanding was checked can provide professional protection,” Lindström said.

Working toward long-term change. “Patient bias should not be handled only by the targeted physician,” Lindström stressed. Even when official policy is lacking, physicians can push for change by advocating for staff training on responding to discriminatory behavior, calling for team discussions about patient bias, and requesting visible messaging to patients that discrimination won’t be tolerated. “This shifts the responsibility back where it belongs — to the organization,” Lindström said. “The ultimate goal isn’t for doctors to become better at enduring discrimination. It’s to ensure that healthcare institutions create environments where they don’t have to.”

Holden, Vogt, Gerhards, and Lindström reported having no relevant financial relationships.