How unconscious bias can discriminate against patients and affect their care

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Older patients are typically sedentary, you assume—without realising it. A patient you relate to well receives that bit more time and attention, although you’re not aware of giving preferential treatment. Or maybe you speak to some patients in a certain way because of your beliefs about their social class. If not these exactly, you’re likely to have made assumptions like them, and all are examples of unconscious bias.

Sarah Mumford, programmes director at IVE, a company that delivers workshops on unconscious bias, describes this type of bias as “what happens when our brains make snap judgments about people, places, and things based upon past experiences.”

Like the wider population, healthcare professionals exhibit unconscious bias, a 2017 systematic review found.¹ Scarlett A McNally, vascular surgeon and a council member of the Royal College of Surgeons of England, says that doctors are “only human” and are therefore not exempt from making assumptions about someone “because of their age, race, sexual orientation, or religion.”

This unconscious bias, also known as implicit bias, is important in a medical setting “because it may affect decision making about how care proceeds,” she says.

Discrimination against patients

Many types of implicit bias discriminate against patients (box 1). Pete Jones, a chartered psychologist at Shire Professional Chartered Psychologists, which provides unconscious bias training, says that it “leads us to value some groups more than others, based on such factors as ethnicity, gender, and disability, which all play a critical role in patient care.”

Box 1

Patients’ implicit biases

It’s not only healthcare professionals who will have unconscious bias—their patients will too. “Unconscious bias can cut both ways in the patient-doctor relationship,” says Scarlett A McNally, vascular surgeon and a council member of the Royal College of Surgeons of England. “Patients may assume that the person looking after them is not senior if they are not the stereotypical image of a senior consultant, and this could lead to a breakdown in communication.”

Ganesh Subramanian, consultant in stroke medicine at Nottingham University Hospital NHS Trust, who has given lectures on unconscious bias, says, “Some patients may dislike being treated by females because they can’t accept them in positions of authority. I have heard this from a number of my female colleagues when they...