Does Medicine Have a DEI Problem?

Is it possible to level the playing field without lowering the standards?

Diversity, Equity, and Inclusion (DEI) policies are back in the headlines—this time, with a stethoscope-themed twist. According to The Telegraph this week, UK medical schools are increasingly offering "contextual offers"—lowering entry requirements for students from disadvantaged backgrounds in an effort to diversify the profession.

The reasoning? Not everyone starts life on an equal playing field. Securing three A-grades in a struggling state school with minimal funding and huge class sizes is arguably a more impressive feat than achieving the same grades in a top private school with an on-site equestrian centre. Few would dispute that. To level the playing field, 17 medical schools have introduced "gateway" courses requiring lower A-level grades. Some now accept students with BBB instead of a minimum of AAA.

Now we know there are skills needed in the profession that A-Levels and IB qualifications can’t test such as emotional intelligence, resilience and the ability to function out of hours with 2 hours of sleep, but equally, there are many that they do: Critical reasoning, use of logic and information retention amongst others.

Here’s where things get sticky: how low can the bar be dropped before it gets too low?

Most people only start caring about this debate when it affects them personally. When boarding a flight, the only thing you care about is how well the pilot did in the flight simulator beforehand, not their disadvantages in life. Similarly, when your loved one is being seen at 3 AM by the F1 on-call, just how much of a hit in quality are we comfortable with in the pursuit of equity?

Medicine, after all, is already under siege. The role of the doctor is being encroached upon by other healthcare professionals, and if we start eroding the academic rigour that has long underpinned the profession, will patients still see doctors as the gold standard?

Additionally, we need to ask if it translates into better patient outcomes? Some studies suggest that patients do better when treated by doctors from similar backgrounds, particularly in cases of cultural understanding and trust. Others argue that competence trumps all, and a well-trained doctor—regardless of background—is the best doctor.

The ideal solution? Perhaps medical schools should maintain high academic standards while expanding support for disadvantaged students after they’re accepted. Rather than lowering the bar, why not offer financial aid, mentoring, and targeted tutoring to ensure students succeed on merit, not mercy?

Risky Business: Do We Understand Decision-Making?

Understanding risk is a skill often overlooked in medical training. Yet, every decision we make balances potential harm against necessity.

Consider the overzealous nurse who tells the on-call resident, “Never cannulate the hand—it’s too painful!” or “Leave the cephalic vein for a future midline!” Medicine is full of such “rules,” but they aren't absolute. They’re reminders to assess risk, not commandments.

Some hospitals ban lower limb cannulation due to amputation risks. Fair enough— A lower limb cannula may go missing under the covers of your typical elderly patient for days. This is fair, except when failing to cannulate means failing to save a life. Very few things in life come with absolutely zero risk. Risk isn't about avoidance; it’s about balance.

The Spectacle of Medicine: Should Healthcare Be Performative?

Let’s re-consider this ‘dream’ of adrenaline-filled, exciting medicine

A fascinating case made waves on X this week from an ED doctor in the States: An elderly patient in V-fib, refractory to five shocks, adrenaline, and amiodarone. The ED team had been discussing dual-sequential defibrillation (DSD) - where two defibrillators are used simultaneously, and when ROSC was achieved beforehand, the Doc responded, “Too bad.” to the resident. The patient later arrested again, endured five more shocks, more drugs, and—remarkably—a stellate ganglion block, which ultimately worked.

The reaction back on this side of the pond - Less awe, more scrutiny. Beyond DNACPR and escalation status discussions, we want to ask: Reading the packaging of the tweet and the content of it - Should medicine be this performative?

The contrast between U.S. and UK medical cultures often boils down to this. In the U.S., medicine is dramatic, fast-paced, and—at times—almost cinematic. High-risk interventions and aggressive escalation are often seen as acts of medical heroism. The economics of US healthcare may feed into this but require discussion in another post. Meanwhile, in the UK, there’s a greater emphasis on protocol, restraint, and resource-conscious decision-making. Neither approach is inherently right nor wrong, but they reflect deeply ingrained attitudes: the U.S. favours intervention; the UK favours deliberation.

We idolise ‘heroic’ medicine—think House MD or Grey’s Anatomy—where a doctor sprints between doing a Burr hole in one theatre and then in the next episode doing a joint replacement. But is that truly what patients need? There’s a reason subspecialisation exists: it improves patient outcomes.

Would you want a surgeon operating on your loved one, eyes wide with excitement, adrenaline pumping, hands just a little shaky from nerves? Or would you rather they feel almost bored by it—like they’ve done it so many times it’s second nature, almost robotic? The better we get at something, the less we have to think about it. Ask a concert pianist; they don’t consciously move their fingers—they just play. The same applies to surgery. Precision comes not from exhilaration, but from repetition.

Experience breeds calm. And in that calm, we catch the small but crucial details—an oozing artery, a missed rhythm change, a subtle clinical sign.

Of course, acute care will always have its high-stakes moments. But let’s not glorify medicine as a performance. The best medicine is methodical, evidence-based, and—dare we say—boring. Because boring saves lives.

“Certificate for your portfolio nearly always proceeds being asked to do something which should really be paid work and does not map to any curriculum requirement”

“I am seeing an epidemic of the phrase ‘this result approached statistical significance’ - Can we please put an end to this”

“Bit of epistemology: Doctors tend to be less confident than non-doctors because we know how much we don’t know and that there is always more to learn.”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Are you sure when a VBG will do the job, or are you still reaching for an ABG just to keep things exciting? Spare your patient the arterial stab—take a look!

Patients with cancers like Lynch syndrome are recommended aspirin prophylactically, and aspirin is making headlines again for its potential to stop metastasis. Funny thing—this is all based on evidence from 2012. Aspirin’s evidence ageing like a fine wine…

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‘GP to Kindly’… Perform Miracles

In a previous On-Call issue, we highlighted how GPs are being pulled in every direction. A 2024 survey reinforced this, with 76% of GPs stating that excessive workloads are compromising patient safety, and 60% admitting they lack the time to properly assess and treat patients.

Yet, every day, they receive the classic instruction: "GP to kindly"—often followed by the impossible. They are increasingly being used to pick up the pieces of a wilting healthcare system.

GP to kindly chase bloods? Manageable. GP to kindly restore full pay restoration, Less so. One watchdog even suggested GPs should be prescribing over-the-counter meds to poorer patients— GP to kindly assess everyone’s finances?

GP to kindly solve the housing crisis. GP to kindly reverse climate change. GP to kindly negotiate peace in Eastern Europe.