March 2026

Why Is It So Hard to Talk About Ethnicity?

Reflections from Interviewing Clinicians about ethnic inequality

By Anna Pathmanathan - Final year PhD student, Bristol Medical School

Interviewing clinicians about ethnicity has been one of the most difficult parts of my PhD research on ethnic inequality in antibiotic prescribing and respiratory health. In the earliest pilot interviews, clinicians showed clear hesitancy. Many paused or softened their responses when asked about ethnicity, worried that acknowledging differences in patient experience or treatment could seem inappropriate. As a woman from a minoritised background myself, and not a clinician, some participants became overly cautious and reserved when talking to me.

I believe several factors contributed to this challenge. The fear of being misunderstood or judged, as clinicians worried their comments might be taken out of context or seen as discriminatory. Concerns about professional reputation, especially as inequity is a prominent and significant concern in healthcare. And finally, talking about “groups” rather than individual patients can feel reductive, especially in a profession that values person-centred care.

My Strategies

Over time, I learned that helping participants feel safe, understood, and unjudged was the key to meaningful dialogue. A few approaches proved especially useful: building rapport, making ethnicity easier to talk about and encouraging reflection from clinicians.

  1. Building Rapport

As I became more confident conducting interviews regarding this topic, I prioritised conducting in-person interviews, allowing me to observe body language and build rapport with more ease. I also chose to present myself as a PhD researcher rather than ‘a student’, to increase credibility. I shared with participants that I am familiar with clinical contexts and GP practices, as I grew up with my parents being practicing GPs, although I am not clinical myself. Finally, I emphasised confidentiality, including that responses would not be linked to individuals or their practice. These approaches to increase rapport appeared to result in increased trust and transparency.

  1. Discussing Ethnicity

The participant information sheet explained the reasons for these interviews and the topic, but I also explained that I would be asking about ethnicity before the interview, so it wouldn’t feel like a hidden agenda. I also shared my own mixed background (Sri Lankan, Indian, White British) to help normalise the topic. I asked all participants to discuss the demographics of their patient population and then used their terminology in subsequent questions. I found it very useful to use discussions about language barriers or migrant experiences as gentle entry points into cultural differences. With language barriers specifically, I believe this encouraged conversation because these are systemic barriers across healthcare, and not due to the specific actions of an individual healthcare professional. Finally, if I still faced hesitancy or discomfort, I discussed this discomfort directly, acknowledged that these differences can be challenging to discuss and reassured them that I am asking clinicians about their experiences of individual patients and not making assumptions about their general views.

  1. Encouraging Reflection

Adding a final open-ended question, “Is there anything else I should know?” led to some of the richest insights. Once the formal part of the interview was over, clinicians often relaxed and volunteered more nuanced reflections, including barriers they hadn’t previously mentioned.

Final reflections and Impact:

Talking about ethnicity in healthcare is uncomfortable for many, but avoiding the topic only hides what contributes to the inequities we’re trying to understand. While not all discomfort can be removed, it can be eased with transparency, empathy, and taking the time to listen to real experiences. Conducting these interviews showed me that honest conversations, however difficult, lead to deeper understanding. And understanding is essential if we want to address the inequities that continue to shape patient care today.