Intended for healthcare professionals

Views And Reviews

Healthcare portraiture and unconscious bias

BMJ 2019; 365 doi: (Published 12 April 2019) Cite this as: BMJ 2019;365:l1668
  1. Karthik Sivashanker, Harvard Medical School fellow in quality and patient safety1,
  2. Kathryn Rexrode, chief2,
  3. Nawal Nour, chief diversity and inclusion officer for faculty, trainees, and students3,
  4. Allen Kachalia, senior vice president, patient safety and quality4
  1. 1Department of Psychiatry, Boston University School of Medicine, USA
  2. 2Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, USA
  3. 3Department of Obstetrics and Gynaecology, Brigham and Women’s Hospital, Harvard Medical School, USA
  4. 4Department of Medicine, Johns Hopkins School of Medicine and Armstrong Institute for Patient Safety and Quality, USA
  1. ksivashanker{at}

The symbols we choose to honour and display can also convey unconscious biases in race and sex

In 2018 a decision to take down from our primary hospital auditorium the portraits of 31 past department chairs, all of whom are male and 30 of whom are white, ignited a fierce reaction in our hospital and surrounding community. Local media articles were flooded with comments accusing the institution of reverse discrimination, with many pledging never to return to our hospital. This incident presents an opportunity for us to examine how the symbols we consciously choose to honour and display can also unintentionally convey unconscious biases in race and sex. Finding the right balance requires that we honour people’s achievements, while also acknowledging the systematic advantages given to some over others.

Respecting history

Many healthcare institutions choose portraiture as a way to celebrate the contributions of past presidents, department chairs, and physician-scientists. With little variation, however, portraits in healthcare and academia have been of white men.12 Many of those responding to the articles in the media thought that the decision at our institution to disperse the portraits in the name of inclusivity was an affront to these people and their accomplishments. They did not see the lack of diversity as evidence of racial or sex bias in healthcare, but simply a reflection of the contributions, accomplishments, and merit of those being honoured.

Without doubt, these leaders deserve recognition for their dedication, excellence, and sacrifice. Healthcare portraits are intended to elicit a sense of institutional pride; they remind viewers of the people who shaped the identity, …

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