Discrimination against ‘foreign’ doctors widespread in Sweden

Discrimination against 'foreign' doctors widespread in Sweden
Sweden's 2010 universal healthcare reform means people can now choose their own doctor and clinic. Jonathan NACKSTRAND / AFP
A Swedish healthcare reform more than a decade ago allowing patients to choose their own doctor has unexpectedly led to widespread discrimination against medics with foreign-sounding names.

“When I was working in psychiatry, a patient cancelled his appointment with me three times because he didn’t want to be treated by a ‘foreign doctor’,” 30-year-old practitioner Navid Ghan told AFP.

“In the end he didn’t have any choice, I was the only doctor available.

During the appointment, even though he saw that I spoke Swedish without an accent, he told me ‘you foreigners, you don’t understand anything’,” Ghan said.

Ghan, whose name has been changed at his request to protect his identity, is not even a ‘foreigner’: he was raised and earned his medical degree in Sweden.

“Now my colleagues and I joke about it in the lunch room. The nurses arrive and say ‘they cancelled again when they saw your name’.”

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Since 2010, as part of a broader reform to Sweden’s universal healthcare system that opened up primary healthcare to private actors, patients have been allowed to choose their own doctor and clinic.

Prior to the reform, Swedes were assigned a clinic based on where they lived.

But as tensions smoulder over rising immigration in traditionally homogeneous Sweden, the reform has made it possible for patients to refuse to be treated by non-ethnic Swedes.

Sweden has seen its immigrant population double in the past two decades, statistics show, and support for the far-right Sweden Democrats has surged to 20 percent to make it the third-biggest party.

Lars Arrhenius is the head of Sweden’s Equality Ombudsman, a government agency that promotes equal rights and combats discrimination.

He said that choosing a doctor based on ethnicity is a “worrying development”.

At the end of March, 1,011 doctors and medical students signed an appeal in daily newspaper Expressen calling on “the responsible authorities to act against racism” in their field.

In July, the country’s largest broadsheet Dagens Nyheter published an investigative series exposing the scope of the problem.

Journalists posing as patients who had recently moved to a new city or town called 120 healthcare clinics and asked that their new doctor be an ethnic Swede.

READ ALSO: Opinion: The Swedish discrimination that dares not speak its name

A total of 51 clinics agreed to the request, 40 refused. Only a handful explicitly said the request was unacceptable.

“We have Maria, Sanna and Elsa. Three fair-skinned women,” one medical secretary told a journalist.

Gender Equality Minister Marta Stenevi, whose brief includes the fight against discrimination, told AFP the practice was “totally unacceptable”, after meeting various actors in the healthcare sector to address the issue.

The head of the Swedish Junior Doctors’ Association, Madeleine Liljegren, said clinics often consented to the requests because of “competition between healthcare clinics over patients.”

The more patients a clinic has, the more state funding it gets.

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Lack of support
“The nurses likely think ‘I’ll agree to their request’ — as shocking and horrible as it is — just to keep the patient,” said Liljegren, noting that some clinics do not have enough patients to stay afloat financially.

Makih Fatelahi, a hospital doctor in the southern Swedish county of Kronoberg whose name has also been changed, says some patients are concerned about communication issues.

“The problem is that they only see your name when the appointment is made.

You don’t get a chance to establish an in-person contact before you get rejected,” the 28-year-old tells told AFP.

The number of cases of discrimination against doctors of foreign origin is not known.

In 2020, more than 3,500 general discrimination complaints were filed to the Equality Ombudsman, 1,146 of which concerned “ethnicity”.

Sweden’s health care system relies heavily on immigrant workers, who are often employed as nursing assistants. In 2020, 2,401 doctors received medical licences in Sweden, almost half of whom earned their degrees abroad.

Navid Ghan said he doe not feel supported by his superiors, even though they have seen the discrimination he has faced.

Many doctors with foreign names complain about a lack of internal procedures at their workplaces for how to respond in such situations. 

“You end up not paying any attention to (the discrimination). I use an algorithm to not let my emotions get the better of me: Does this patient really need my help? If yes, I take care of the patient and ignore the comments. If not, I ask a colleague to take my place,” Ghan said.

Member comments

  1. Statistically speaking, with a rather low sample size, doctors with “Swedish sounding” names have failed miserably in many cases of mine and my sambo, to the point that we had to go to another country to get actual treatment. I would pick a “foreign” doctor any day if he/she is not of the method “let’s try this and see what happens”…

  2. Once I was discussing the problem of racism with a Swedish psychologist. He described it to me as: “racism and xenophobia are some kind of mental disease, where the mind does not have the capability to accept and embrace differences among people. Such a mind is in a constant state of fear from those who look/sound different. It can go so far as to even attack elderly and disabled people just because they might look different. You should feel sorry and have pity for the bearer of such a mind”. I liked his point of view but was not convinced what to do when confronted with such people. Because it is not always enough to feel sorry for the racist when they are directing a verbal/physical attack against you in a public environment.

    At some point, I discussed the matter further with a Canadian gentleman who worked for several years in foreign countries with rather hostile environments, where he was subject to verbal/physical altercation due to his foreign exotic look. His advice was “It’s the proximity, put some distance between you and the racist/xenophobe. Try to de-escalate the situation with some verbal judo.” He continued: “Just say, why don’t we just go about our business and have a nice day?”. He added that the bottom line of such confrontations could get very serious and it was important to evade it to avoid the repercussions.

    Now, I find the situation described in this article very tricky to deal with for doctors who might not look like the average Svensson. They cannot just avoid the “proximity”, or use verbal judo. However, I think Dr. Navid Ghan mentioned in the article has a very smart algorithm that incorporates both elements I mentioned earlier, that is, to feel sorry for the racist, and to avoid them when possible. When he sees a racist patient in need, he sees the need and treats them with compassion. When that is not the case, he just distances himself from the situation and avoids the “repercussions”. Good job! 🙂

    1. Hi SR, it’s hard to answer your question because I don’t know where to start. There are numerous studies on racism in all disciplines of the social sciences and the humanities. In Sweden, because the delusional image of a “progressive” anti-racist nation is still being sold, the government has sometimes generously funded a number of studies on racism. You could easily find such studies in many sociological and ethnographical departments at Swedish universities. For a particular research on racism in the Swedish healthcare, I believe Suruchi Thapar-Björkert at Uppsala University is currently working on such a project. Uppsala University also has Centre for Multidisciplinary Studies on Racism (CEMFOR) where seminars and talks are regularly organized, and if you’re interested, I think you could possibly join in CEMFOR by online participation. I’m, however, more interested in the humanities approach to racism. For my bias, I can recommend delving into the philosophical and psychological works of Frantz Fanon and Octave Mannoni because they touch upon the ontological and existential question of blackness and being-black. For a phenomenological approach to racism, I can recommend reading Sara Ahmed’s works. Saidiya Hartman’s “Scenes of Subjection” and “Lose Your Mother” can also help to understand the disastrous effects of racism, colonialism, and slavery in the aftermath of “decolonization.” These works might cause you a little uncomfortableness. But I believe it’s better to face. Take care!

      1. Hi!
        Thank you so much for taking the time to provide such valuable references together with useful commentary. I have saved your response in a file so I can refer to it later. Just by looking at your response, I already see that this is such a vast topic and there is so much to learn. I feel very humbled by it. Thanks again and you take care too!

    2. I wouldn’t say racism is a mental disease. Racism is neither a pathology nor a prejudice. Racism is a condition of life – just like capitalism, colonialism, and all types of exploitation. To eradicate racism requires a change of the whole structure.

      1. Racism indicates a weakness of mind and a weakness of character. An active willingness to see another human being as something less-than yourself, or even less-than human. It’s weak and shameful, and should be called out such

        1. Again, it’s absolutely therapeutic to say racism is something to be blamed individually. So sad to see that those suffering from racism cannot even understand their condition of living and why and how racism works against them. There have been a lot of studies on racism from the humanities and social sciences. I guess you could have been enlightened by spending something critically reading and critically thinking about it.

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