Unconscious bias within the healthcare sector 

Tabitha Kusi- Yeboah. Edited by Omolara Akinnawonu • June 17, 2020

Introduction

The provision of equal healthcare for all patients, irrespective of their identity is an important pillar of many healthcare systems (Jamison D et al., 2006), this core value of patient care is often compromised because of the presence of unconscious bias. Unconscious bias is the product of associations made outside of conscious awareness (stereotyping) that lead to the negative treatment of groups of people based on “irrelevant” characteristics such as race, gender, age and so on (Fitzgerald C and Hurst S, 2017).

Implicit racist bias and the effect on health outcomes

In this current environment of understaffed healthcare systems, time pressured consultations and routinized procedures, medical professionals still aim to maintain the intricate necessities which aid in enrichment of patient-physician relationships and interactions. It is of the general consensus that the patient-physician relationship does have a statistically significant effect on health care outcomes (Griffin S et al., 2004) (Harrington J et al., 2004)(Kelly J et al., 2014).

In contrast to racially concordant consultations (physician and patient of the same race), racially discordant consultations have been recorded as being less positive, and have been characterised by less patient trust, less effort invested into building of patient physician relationship and less joint decision making (Johnson R et al., 2004)(Cooper L et al.,2003)(Simonoff L, 2006)(Koerber et al., 2004). It may be of little surprise therefore, that implicit racist bias has been pinpointed as responsible to some extent for the disparity in health care outcomes between minority and non-minority ethnic groups. These findings are supported by studies in Social Science and Medicine by Nao Hagiwara and colleagues (2013), who found that physicians with a high implicit racist bias score had a tendency to dominate most of the interaction time between themselves and patients during consultations and to use language that implied a presence of power disparity. The presence of implicit racist bias therefore has the power to degenerate the patient-physician relationship, affect the efficacy of patient consultations, and by domino effect, the outcome of such consultations.




Implicit racist bias has also been shown to have more direct effects on patient health outcomes. Particularly pertinent examples of this pertain to physicians’ perceptions of differing levels of pain thresholds between white and black patients (Hoffman K et al., 2016). For many centuries, there has been an overarching belief that black people’s bodies are biologically and fundamentally different from those of their white counterparts (Morning A, 2011). This belief manifested in devastating ways in the past, such as during slavery when black men were believed to be more powerful and efficient at manual labour than white males, and hence were treated as valuable commodities for the purpose of work.

‘Research shows that these biological misconceptions are correlated with the implicit racist bias that manifests within our society, with pain perception in medical practice being just one of many examples of this (Williams M and Eberhardt J, 2019).’

Combatting Implicit racist bias in medical practice

Medical associations have the responsibility of combatting implicit racist bias, this starts with making those within the medical practice aware of their implicit bias views and guiding them with practical methods and solutions as to how they can reduce their bias. Burgess et al (2007) go further to suggest that informing medical professionals of the fact that stereotyping and implicit bias are “normal aspects of human cognition” may make them more comfortable with learning about this phenomenon and its effects within medical practice. Although I partly disagree with this statement, as I believe it has the potential to breed complacency and comfort with one’s own implicit (racist) bias, this statement is duly supported by studies which show that a large fraction of the population tends to feel uncomfortable when talking about race and racism (Martin C, 2018).

Dr Augustus White’s book on “Seeing patients: unconscious bias in health care” suggests a solution as simple as medical professionals having a basic understanding of cultures that patients come from to help reduce their implicit racist bias. This solution points to the issue of a lack of diversity of medical professionals. If there was greater diversity within the healthcare sector, this would likely give opportunity for expansion of medical professionals’ exposure and by effect their understanding of other cultures.

Dr White appeals to medical professionals to remember to assiduously practice evidence-based medicine (EBM); A core element of modern medical practice. (White A, 2011)

EBM incorporates research evidence, clinical expertise and importantly patient values and should leave no room for implicit bias to alter the objective quality of care received by one patient compared to another (Masic I et al., 2008).


Conclusion

To conclude, implicit racist bias indeed exists within the healthcare sector and its effects defy the very pillars and core practices of modern-day medicine.

Unconscious bias is arguably harder to tackle than conscious bias; the intentional unfair treatment of groups of people, as it requires an individual’s willingness to change their behaviour regardless of their awareness of their bias, when the effect of their bias is exposed.

In an era where health equity is a continuous goal, more needs to be done to combat it.


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Impact of COVID-19 on experiences of BAME doctors and future steps:

By Zurafa Sakel • May 6, 2022
Prejudice occurring in the pandemic has disproportionately impacted BAME professionals - how can we respond?

In Conversation with: Dr Patrice Baptiste

By Dr Patrice Baptiste. Edited by Omolara Akinnawonu • January 7, 2021
1) Introduction: About yourself and the career speciality you are in now? I am a portfolio GP, medical educator, entrepreneur, writer, author, visionary and champion for diversity within the medical profession. As a portfolio GP, I spend the majority of my time in clinical practice with the remainder of her time divided between a number of other careers and interests. As a medical school examiner at Queen Mary University London I examine students during their practical or Objective Structured Clinical Examinations (OSCEs). I also works for the General Medical Council (GMC) examining doctors who have qualified abroad and wish to practice in the UK through my role as a PLAB (Professional and Linguistic Assessments Board) examiner. Through my company, DreamSmartTutors, which launched during 2016, ( www.dreamsmarttutors.co.uk ) I support prospective medical students on their medical journeys whilst simultaneously aiming to increase diversity within the medical profession. As a STEM ambassador, I also aim to encourage school students to pursue Science, Technology, Engineering and Mathematics (STEM) subjects. I am also a keynote speaker, having delivered a number of talks at places such as Oxford university, The British Medical Journal (BMJ) Live Careers fair and The Royal College of Physicians Edinburgh. As a freelance writer I have written for the British Medical Association (BMA), the BMJ, the Medical Protection Society (MPS) and the Support for Doctors Network to name but a few. I regularly contribute to GP online ( www.gponline.com ) discussing important topics pertaining to General Practice and have published a short guide for those looking to understand a medical career in addition to this first of four poetry books. These can be found in the 'Publications' section on her profile below. 2) What is the most rewarding/most challenging aspect of your job? I enjoy being able to establish and maintain a long term doctor patient relationship with my patients. This is very difficult to do when working in the hospital. I am also able to follow patients up and provide continuity of care. This enables me to provide a high standard of care for my patients. 3) What can medical students/ aspiring students do now to get to where you are now? Everyone has a different path and therefore my advice would be to get to know yourself, your personality, what you enjoy and don't enjoy. This will enable you to create a unique career path that you are happy with. 4) What advice would you give your younger self ? Don't worry so much. Often the things I worried about during my journey to becoming a doctor were so unimportant looking back and I can barely remember what the worries were about! If you find you are a worrier then ask yourself, whatever you are worrying about in the grand scheme of things does it really matter and will it matter/will you remember it in 5-10 years? If the answer is no, then try not to worry so much! 5) What inspires and motivates you to do the work you do? I have always been an ambitious and highly motivated person. I enjoy learning new things and developing as a person.

Maintaining faith in medicine

By Ellen Nelson Rowe. Editied by Omolara Akinnawonu • December 7, 2020
In a world where there are prevalent medical ethics, such as recently stances on physician-assisted dying, views on abortions, gender and much more, I believe that maintaining faith has been so important to face these challenges and approach them with Godly wisdom. Faith for me has also been my first comfort in the stresses of medicine - the huge workload, the long working hours, the emotional labour. Making faith a priority can definitely be a challenge and my aim is to share some principles that I have found useful in managing this!

Still we rise.

By Toyosi Omotoso. Edited by Omolara Akinnawonu • October 25, 2020
Growing up black comes with so much hardship, however, when faced with adversity, we are still able to rise and accomplish extraordinary things. With the resurgence of the BLM campaign alongside the protests happening in Africa, Black History Month is especially important this year, despite it being difficult to celebrate our success whilst enduring hardship. Africa is such a powerful continent with rich culture and resources and has so much to offer, but neo-colonialism and poor leadership have prevented it from its potential. In Nigeria, there are END SARS protests against brutality and oppression by the police. SARS Special Anti-Robbery Squad was created in the early ’90s to protect its people, yet over the years instead of protecting its citizens they have abused their position of power and murdered and tortured their people instead. People deserve to be able to live in peace and not live in constant fear. In Namibia, there are protests against sexual and gender-based violence and there's currently a holocaust going on in Congo. Ghana and the Ivory coast children are being trafficked, in Cameroon, there is the anglophone crisis and in South Africa, there is a rise in femicide. During the Black Lives Matter movement earlier on this year, we stood as one and our voices were being heard. We need to continue to use our voices and spread awareness for there to be change because all black matters matter everywhere. These are devastating times and it can be so heart-breaking and overwhelming especially having to face it daily, the weight of this can be unbearable but it needs to be acknowledged. We cannot live fulfilling lives without overcoming the hurt and the anger. Adversity as a black woman is nothing new; our hair, character and sexuality are constantly scrutinised but when it comes to our safety and the way we are treated people are not concerned in the slightest. 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Even in Nigeria the government, most importantly President Buhari has a duty to its people and to do right by them but rather than obliging the basic cry for help from the youth of their country they are governed by greed and corruption. Black Pound Day (BPD) founded by Swiss; a member of So Solid Crew, started for the first time at the end of June and allows us to celebrate black-owned businesses and help circulate more money within our own economy, which in turn helps us to give back to our community. Maya Angelou said, ‘You may shoot me with your words, you may cut me with your eyes, you may kill me with your hatefulness, but still, like air, I’ll rise.’ BPD helps showcase smaller businesses and gives us a way of celebrating our culture and success. GUAP media company has shown a new and innovative approach of displaying and promoting diverse individuals within the creative industry. Their magazine the Renaissance issue this year featured a prominent figure in the UK creative industry Nella Rose on the cover, which captured not only her beauty and showcased her talent and culture but highlighted the importance and influence she has within the community and despite the injustices we face we are still able to flourish. Sharon Chuter of Uoma Cosmetics came out with a Pull Up for Change initiative, which helps give economic opportunities to black people. The aim of her campaign is to hold brands and companies more accountable. It asks the ones who came out in support of the Black Lives Matter movement to release the number of black employees in the organisation especially in executive and senior roles. Many companies showed solidarity and support publicly, but it is important to see what companies are doing behind closed doors and what they are going to do to improve. This month is all about highlighting our success and educating ourselves and others as well as learning from these experiences. We still must be able to celebrate ourselves as a community and be able to uplift ourselves whilst recognising our struggles. We can celebrate ourselves by not being ashamed of our culture and truly embrace it particularly when it comes to food, clothes and our hair and normalising sharing our culture to our friends of different ethnicities. By Toyosi Omotoso University of Ostrava

Why is Black History Month important?

By By Nana Asafu-Adjaye. Edited by Omolara Akinnawonu • October 15, 2020
“Why do we still need Black History Month (BHM)?” “It disregards other POC communities” “It’s way better than it used to be” “We don’t have a White History Month!” Sound familiar? Perhaps there is an element of truth to these statements. A truth that believes that things are actually getting better, that the black struggle isn’t “as bad” anymore or that we are creating our own division by only showcasing our success and not everybody else’s. But who is this rhetoric true for? As a young black woman, I take pride in celebrating BHM. I believe the foundations of our past must be brought to light, to not only black people but the world. The unfortunate reality is that we live in a world where those that have suffered at the hands of societal norms are not seen the same as their counterparts.

Malone Mukwende - Failing to start: Why we accept mediocrity and how to change! 

By Malone Mukwende. Edited by Omolara Akinnawonu • October 12, 2020
Hi, my name is Malone and I'm a third year medical student at St Georges University of London. I am one of the Co-authors of mind the gap which is a clinical Handbook of signs and symptoms in black and Brown skin. The summer has been quite hectic since I posted the work of Mind the gap on my Twitter page on the 18th of June 2020 as ‘Mind the Gap’ has been viewed over 100 million times with notable mentions from celebrities such as John Boyega, Lupita Nyonggo and Priyanka Chopra. I noticed there was the issue at medical school on the lack of teaching in darker skins on arrival this was very concerning to me because I was almost unable to even spot signs and symptoms on myself. I knew that if I couldn't do this on myself then how am I expecting myself to be able to do this on others. With increased awareness on some of the healthcare disparities that exist in the UK such as black women being five times more likely to die during childbirth and black men more likely to be sectioned under the Mental Health Act it became apparent to me that something needed to be done. I have spoken about ‘Mind the Gap’ on various platforms so I won’t repeat the same story again for this platform. Alternatively, I'm going to use this platform to speak about the impacts that it has had thus far on both myself and the world. Over the past two months had featured in many news articles such as the Washington post, Sky News, ITV News, BMJ, and the CBC in Canada. This has led to a great amount of attention surrounding my name. Unfortunately, with this attention has come a lot of hate. Many people we’re unaware of the need for ‘Mind the Gap’ and it almost felt like I was creating unnecessary agendas and given the political climate of the world in 2020 many people felt entitled to try and stifle our attempts. Of course, everybody is entitled to their own opinion and thoughts however many would go out of their way to express their thoughts by sending hateful messages and emails. As a student who is just trying to do something positive this of course would get me down, however one thing that I knew is that change will always be met with resistance. It was clear to see that some people hating the fact that ‘Mind the Gap’ was having such a good impact. Before the ‘Mind the Gap’ Handbook was released I could see a shift and a hyper awareness from the world that we need to do something about the lack of diversity in imagery. I could see that many news articles were now starting to include signs of how conditions present in COVID-19 on darker skin. This was extremely positive as I didn't believe that my co-authors and I could have such a big impact on the world. My aim with this blog post is to illustrate how resistance is a by-product of change. I want to use this opportunity to help people acknowledge that sometimes your ideas won't always be met with open arms however don’t let that get you down. This message is for anybody who may have an idea but is almost holding themselves back due to fear of not being accepted. I think it's so important to have faith in your own work and then from there everything else will fall into place. To keep up to date with mind the gap and associated posts please follow my social media. Instagram @malone_187, Twitter: @malone_mk Catch us interviewing Malone on Tuesday 27th October at 7pm over on our instagram @acmedicalmentors

Black Impact in Medicine: How this shaped the journey to medicine for me

By Emefa Vondee. Editied by Omolara Akinnawonu • October 6, 2020
“Accomplishments have no colour.” - Leontyne Price This statement says a lot in a few words - partially true in my opinion. For example, when we turn on lights or boil a hot cup of tea, we never sit down to think about the racial background of the respective inventor/creator. However, have you ever wondered what contributions our own black people have brought to the table? What about in the realm of medicine? We don’t learn much in school apart from how black people were oppressed. However, at notable times of the year such as Black History Month, we now have a chance to celebrate how far black people have come.

My dental journey so far

By By Nana Asafu-Adjaye. Edited by Omolara Akinnawonu. • August 28, 2020
Where do I even start? This journey was not an easy one AT ALL. It’s been a long and untraditional journey but nevertheless one of the most rewarding things I’ve ever done. LESSON #1: Even When Things Are Going Great, Don’t Get Comfortable In Year 11, I did 10 GCSE’s and managed to get: 4A’s 2A*, 3B’s and a C in Physics which to this dayyyy still baffles me, the subject just has me like

Studying as a graduate entry medical student

By Monique Wheatle. Edited by Omolara Akinnwonu • August 11, 2020
Medicine is all I have wanted to do since I was about 15. I never had a concrete reason why, but I would say I’m quite an intuitive person, and my spirit just took to medicine, it fit for me. I failed to secure an offer the first time round, so after achieving a first-class degree in Biomedical Science, I currently study Graduate Medicine at the University of Birmingham. Studying medicine as a Graduate is rewarding, and for the most part very enjoyable. I can’t see myself doing anything else. However, it has brought certain challenges which I wanted to share in this post for anyone that can relate to this, whilst giving a realistic idea for those considering it. Firstly, it is really intense, I will be studying consecutively for 7 years. Within that time, I have completed one degree, applied for Graduate Medicine (which is extremely competitive) and studied the entire 2-year preclinical course in less than a year. This is why it is so important to take breaks and be realistic with your workload to avoid burning out. I have multiple outlets which give me a breather and allow me to enjoy myself outside of medicine. I play netball, spend time with loved ones, run ACMM, attend every soca event possible and countdown to carnival every year. These things allow me to have a life outside of medicine which is crucial. Also, the funding for the Graduate Entry Course is substantially different to the undergraduate course. For the first year, it requires a contribution of over three thousand pounds, and in subsequent years you get a combination of student finance and the NHS bursary which is usually less than your previous student finance loan. It is therefore common that there is a financial pressure on graduate students, which is why many have a year out prior to beginning the course in order to save. I had an offer straight from Biomedical Science so was not able to do this. Unfortunately, financial pressure is not uncommon amongst students in general, but it is an even more important consideration for Graduate Entry Medicine.

Words to my younger self

By By Dr Rumbi. Edited by Omolara Akinnawonu • August 3, 2020
2020 has been a rollercoaster of a year. It feels like with each progressing month another level of Jumanji is reached. This year was one I had so many plans for, particularly this summer, the summer I was to graduate and finally become a doctor after 8 years of university. There were times in the previous years where I just wished I was finished; I wished I was graduating already. At times I envied those graduating whatever year it might have been. As the saying (or the pussycat dolls song) goes, be careful what you wish for, because you just might get it. In April 2020, my wish came true. The circumstances however were those beyond what my mind could even imagine, a virus taking countless lives, keeping loved ones apart, sweeping the globe. If you told me three months ago that today, as I’m writing this post, I would be in my first working week as an employed doctor? I would not have believed you. Three months ago I had only just written my finals, celebrated with travel, well, I came home to a different world than when I stepped on the plane to leave. Class of Covid-19 as I like to affectionately call us, has been called up for duty. Who knew a global pandemic chose the year in which I was due to qualify to make its entrance into the world. I write this open letter to my younger, student, self and other medical students (both current and future) to say this. Don’t wish away where you are now, because tomorrow might not be what you expect. Each season in life has its purpose. The times I cried because I didn’t get any offers to study medicine? Well they led to me finding joy in Midwifery. The days when I worried how I would pass my exams, study and find go to work; they led me to be resourceful and manage my time. Not everyone believes in fate, or in destiny but I believe all those times and moments where leading up to this season, starting as a doctor in the most extraordinary of circumstances. These days will be written about in the history books and we are living through them. There is a lot of uncertainty for medical students and those that were planning to apply this coming September. There is restructuring of exams, cancelled placements, virtual lectures and other socially distanced changes. Take all the anxiety and worry that might come with the uncertainty and consider this an opportunity. Take hope and comfort in where you are now, for it is preparing you for where you might be tomorrow. Don’t wish away the experiences you are having, embrace the hurdles because they train you to jump higher. I know it is easy for me to say because now I am at the other end of this journey but with every ending there is a new beginning, different challenges, more lessons. More on early provisional registration of final year medical students and its impact on medical students Covid-19: medical schools given powers to graduate final year students early to help NHS Joint statement: early provisional registration for final year medical students Medical Students Are Not Essential Workers: Examining Institutional Responsibility During the COVID-19 Pandemic The Impact of COVID-19 on Medical Education