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During the first week after the UK voted to leave the EU, the frequency of hate crimes being reported increased by an incredible 57%, according to the police-funded hate crime reporting website ‘True Vision’. Reporting charity ‘Stop Hate UK’ and anti-Islamophobia organisation ‘Tell Mama’’ also reported dramatic increases in the rate of reports of racism and xenophobia. News websites and social media channels were awash with reports of abuse directed towards EU and non-EU migrants by British citizens who believed that a successful vote for Brexit gave them a free pass for hate speech. These scenarios occurred all over the UK, even in healthcare environments.

The ‘Nursing Times’ reported that non-British nurses currently feel unwanted and unsafe in the UK, not only as a result of the referendum vote but due to direct abuse they had experienced from members of the public who have told them to 'go home'. GPs have had to deal with similar instances of abuse. It is not just EU migrants who have been subject to such abuse either - British citizens from ethnic minorities have had to deal with patients demanding they leave the UK. These scenarios are undoubtedly difficult for GPs, nurses and other healthcare workers to deal with, and pose serious questions as to how to deal with threatening or abusive patients while remaining professional.

Coping with racist comments/attacks from patients

During the early aftermath of the Brexit vote, a story on social media was widely reported in the media and is a strong example of how healthcare professionals are coping with instances of racial and xenophobic abuse. A speciality trainee tweeted about an instance in which his Sikh radiographer colleague was asked by a patient, "Shouldn’t you be on a plane back to Pakistan? We voted you out.” The radiographer's response was to be unaffected by the comment, smile at the patient and continue with his work as normal. Although ignoring these abusive comments is undoubtedly professional, there often comes a time where such abuse could result in the breakdown of trust between the healthcare professional and patient.

The General Medical Council outlines in section 3 of Good Medical Practice the guidance on ending professional relationships with patients:

"In rare circumstances, the trust between you and a patient may break down, for example, if the patient has:

-  been violent, threatening or abusive to you or a colleague - stolen from you or the premises - persistently acted inconsiderately or unreasonably - made a sexual advance to you."

Racist behaviour toward a doctor, nurse or colleague made by a patient who is unwilling to retract or reconsider their position could in our view fall within abusive behaviour or acting inconsiderately or reasonably, and may be grounds for a healthcare worker to end their relationship with a patient.

We would caution that in cases of racist behaviour by patients directed towards you or a colleague it is important to warn the patient that it is part of your duty to promote equality and diversity, that their behaviour is racist and so places you in breach of your duty. You should invite them to apologise and retract their racist behaviour and point out that in the absence a retraction the may be an irretrievable breakdown in trust between you and them which would lead to ending the professional relationship. You should take whatever measures possible to resolve the situation or find an alternative, and discuss the situation with a trustworthy colleague or defence organisation. If ending the relationship still seems the most appropriate course of action, you should then notify the patient - in writing where possible - and carefully document in the patient's notes the conduct which caused the breakdown of the relationship and the steps taken to seek to resolve the position.

Since we're still in the early stages of the referendum's aftermath, it is too soon to say whether the vote will lead to a significant increase in healthcare workers ending professional relationships with abusive patients. However, in these turbulent times, NHS doctors and nurses from both within the EU and beyond should remember that the option to terminate patient relationships is a possibility should they have violent, racially threatening or abusive behaviour directed at them or a colleague.