Intended for healthcare professionals

Feature Discrimination in Medicine

How unconscious bias can discriminate against patients and affect their care

BMJ 2020; 371 doi: (Published 03 November 2020) Cite this as: BMJ 2020;371:m4152
  1. Kathy Oxtoby, journalist
  1. London
  1. kathyoxtoby1{at}

Our assumptions, which we may not even be aware of, can lead to erroneous clinical decisions. More research, awareness, training, and diverse teams are needed to tackle this, Kathy Oxtoby finds

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 …

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