Subconscious Bias in Patient-Care

A recent study has found that female patients are 32% more likely to die from surgery when performed by a male surgeon, compared to a female surgeon (you can read about it here).

Just sit with that statistic for a moment...

“Implicit sex biases”, in which surgeons “act on subconscious, deeply ingrained biases, stereotypes and attitudes”, may be one possible explanation, said Dr Angela Jerath

Subconscious bias is one of the biggest barriers today to providing universal patient-centred care. The problem is - even though it is subconscious - most healthcare professionals believe that this sort of stuff doesn’t apply to them.

But this is NOT how subconscious behaviour works!

Our ego will step in every time and tell us stories like "But I'm not a racist, or a classist, or a misogynist. I care about all my patients”. This may be true on the CONSCIOUS level, but in order to truly realise and rewire our subconscious behaviours, we have to go deeper - beyond rational thought alone.

This is where tools such as meditation and breathwork can have a huge impact on how we show up as healthcare professionals. This work is about getting beyond our ego - the stories we believe to be true - and gaining a deeper understanding into the way things actually are. Most of the time, these subconscious biases and behaviours stem back to our early childhood. They are engrained into us and we accept them to be true - just as much as we accept that the sky is blue and dogs bark.

This study is a perfect (yet unfortunately very sad) example of how we are not as aware of our behaviours and thoughts as we’d like to admit. Values and attitudes towards women in society are slowly shifting, but there’s no denying that there has been a cultural acceptance that women are valued less than men. I’m not saying that the male surgeons performing these operations on women are misogynistic or "bad eggs", but the evidence in this study definitely suggests that this cultural bias has negative impacts on our patients.

And it doesn’t stop at gender. What about race? Religion? Socioeconomic status? We have been told what to believe about these demographics from a very young age, and it can take a lot of hard, honest internal reflection to rewire that as an adult.

I'll give you a personal example (one that I'm not proud of, but I feel is important to talk about). I am a Caucasian male who grew up in regional Australia in the 90's. I did not see much ethnic diversity during my childhood. To be honest, most people of colour that I did see where on television. And unfortunately, most of these people were depicted as either "bad", "dangerous" or lower down on the socioeconomic status, which is often interpreted as "less important".

Now, I have never considered myself to be racist. As an adult, I try to treat people how I would like to be treated, and I'm careful about getting caught up in stereotypes. Still, when I began to do more inner work, and tune into how I was thinking, feeling and acting throughout the day, I noticed that when I would see a person of colour walk by (or an ethnic patient stand up in the waiting room), my sympathetic nervous system - fight or flight - would kick up a gear. The thing was, I didn't consciously register that I was afraid or on guard, but my body would enter that mode anyway.

If I reflect back on what level of care I provided for these patients compared to Caucasian patients, there is no denying that I would have subconsciously treated them differently. As to what that meant for their outcomes, hopefully in my circumstance it wasn't too impactful. It's difficult to say for sure.