# Negotiating responsibility: How German healthcare professionals navigate racism between recognition and resistance

## TL;DR

This study explores how German healthcare professionals experience and respond to racism in their work, highlighting the need for structural changes to address racial inequities in healthcare.

## Contribution

The study provides new insights into how implicit racism is reproduced in German healthcare and the barriers to addressing it effectively.

## Key findings

- Implicit racism is pervasive in healthcare interactions, often reproduced through culturalizing discourses and essentialist models.
- Healthcare professionals show varying levels of awareness and reflexivity about their role in perpetuating racism.
- Structural support and institutional infrastructure are lacking to help professionals address and dismantle racism.

## Abstract

Research on everyday racism in healthcare remains limited, particularly in Germany. This study examines how healthcare professionals perceive their own conduct toward racialized healthcare users and explores the interpretive frameworks that shape these perceptions. By focusing on the everyday concepts that guide clinical encounters, the analysis highlights how racism is reproduced within healthcare interactions and offers insight into the knowledge frameworks and institutional processes that sustain inequities in care.

We conducted problem-centred expert interviews with doctors, nurses, and members of the therapeutic professions (occupational therapists, physiotherapists and psychotherapists) working in hospitals and rehabilitation facilities in Germany. Participants were recruited systematically across three German states and interviews were conducted by telephone, in person or via videoconference. They explored respondents' observations of racism within their institutions, reflections on their own role in reproducing it, and their assessments of existing structures and further needs for effectively addressing racism in healthcare. Data were analyzed using the documentary method.

Twenty-one healthcare professionals were interviewed for this study. The analysis shows that implicit forms of racism remain pervasive, yet respondents displayed varying degrees of reflexivity and awareness about how racism is reproduced in everyday practice, including recognition of their own roles within these processes. Even participants engaged in antiracist efforts frequently relied on culturalizing discourses and essentialist explanatory models. While some respondents critically examined their own positionality and used their professional privilege to intervene in racist situations, such actions were typically ad hoc and lacked structural support.

Many respondents expressed uncertainty about how to define or analyze racism, underscoring the need for a broader public dialogue on the issue. Moreover, during their training, healthcare professionals are exposed to not only the formal curriculum but also a hidden curriculum, which subtly conveys implicit lessons about professional conduct, social hierarchies, and attitudes toward racialized patient groups. Not least, the data demonstrate the lack of institutional infrastructure to support healthcare professionals commitment to dismantle racism. Because meaningful change requires structural interventions, there is a clear need for measures that enable all healthcare professionals to contribute effectively to dismantling racism.