I imagine we’ve all been in a similar position before: a patient or client you don’t recognise presents with vague symptoms. Before they’ve finished their sentence, you’ve already formed an impression shaped by their appearance, manner of speech, perhaps their name or surname on file, the colour of their skin, or their gender. This isn’t a reflection of your professionalism; it’s how your brain manages complexity under pressure, and is an example of implicit bias. Every clinician does it, whether they notice (or admit to it) or not.
Implicit bias refers to the unconscious, automatic associations that influence our judgements and behaviour.¹ This operates independently of a person’s stated values or intentions but may hide negative associations in thoughts and actions. For example, you may consciously value equity; however, your implicit bias may activate negative stereotypes about someone with a certain skin colour, perceiving a patient as less competent and deciding that they wouldn’t understand medication information, so you don’t provide it. A systematic review of the research has found a significant relationship between level of implicit bias and lower quality of care, regardless of their explicit commitment to equitable care.¹ The gap between what clinicians believe and how they behave under cognitive pressure is the subject of this Mindful Monday, not personal prejudice.
Clinical environments are almost purpose-built to activate mental shortcuts that allow people to make decisions quickly and solve problems. For people working in rural and remote settings, several structural features amplify this risk. For example, small communities mean dual relationships are common, so you may know more intimate details about someone who presents, which unconsciously informs your decisions. Workforce shortages also compound decision fatigue and, without adequate recovery between demanding episodes, our cognitive resources deplete, meaning we’re more likely to rely on our biased shortcuts.
No one likes to think of themselves as being racist, sexist, ageist (or any of the other ‘ist’) and that they resort to stereotypes to judge someone in a situation, and our instinctive response to learning about our own implicit bias is often one of shame or defensiveness. However, our brain is shaped by evolution, culture and our life experiences.
- Evolution has helped develop our brain to spot threats instantly, to recognise patterns to help save energy, and to make quick, automatic decisions.
- Culture has influenced our brain development through media, which exposes us to repetitive stereotypes; and
- Life experiences, including our social upbringing, whereby we absorb biases from our parents and peers, and societal structures that reinforce inequalities over time.
We can also develop implicit biases from personal experiences, such as a lack of exposure (isolation breeds fear of the unknown); single negative events which can form lasting stereotypes; and learned associations linking traits based on your environment, e.g. subconsciously associating individuals from marginalised racial backgrounds as a greater threat due to repeated exposure to biased news and entertainment media.
Feeling ashamed or defensive does not support change here; individual awareness does. Whilst eliminating implicit biases is difficult, their impact can be mitigated through awareness and structural safeguards, such as decision tools and debriefing, which are further explored in the below suggestions.
Conscious deliberation. Where possible, slow down the decision-making process (even slightly) to avoid snap, stereotype-based judgements. When you think you might be making one, or notice you are, reflect on where it might have come from. There is a saying that your first thought or judgement about a person or situation reflects your upbringing and conditioning, while your second thought defines who you are. Treat this as an opportunity to change and align your automatic thoughts with your values.
Structured decision tools. Checklists and standardised assessment and treatment protocols help reduce reliance on implicit biases in moments of cognitive pressure. They can help eliminate any influencing information and allow you to focus on treating only the symptoms in front of you, which is handy for emergency-type situations.
Reflective debriefing. When you have more time to spend with someone, notice if any biases or judgements pop into mind. Take note of these, and have a reflective debriefing session with someone safe, such as peers or a supervisor. This can help normalise this human experience and also introduce different perspectives of the situation that your own blind spots may have missed.
Exposure. Intentionally interacting with people from diverse backgrounds and getting to know more about them as people, their culture, their likes, dislikes, hopes and dreams helps to create new and positive mental associations. Never underestimate the power of simply having a cuppa and a yarn with someone.
Research has found that bias-reducing training alone rarely sustains behaviour change unless it’s supported by, and embedded in, the working environment.² Systemic interventions such as workload design, rostering that protects recovery time, and normalising reflections or debriefs should be standard practice, and are just as important as your own individual reflection.
Implicit bias is a predictable shortcoming of human thinking under pressure, not a character flaw you may feel you need to hide. Naming it openly, implementing structural safeguards, and approaching your own blind spots with the same compassion you show to patients can transform your bias from a source of covert shame to a manageable and shared feature of good practice. Next time you notice a snap judgement forming, pause and ask yourself, “What’s driving this? Is it the patient in front of me, or the shortcut my tired brain has reached for?” That moment of noticing is where change begins.
Be kind,
Dr Nicole Jeffery-Dawes (she/her)
Senior Psychologist, Mental Health and Wellbeing
- FitzGerald, C & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18(1), 19. Accessed 21 July 2026 at https://pmc.ncbi.nlm.nih.gov/articles/PMC5333436/
- FitzGerald, C., Martin, A., Berner, D. & Hurst, S. (2019).Interventions designed to reduce implicit prejudices and implicit stereotypes in real world contexts: A systematic review. BMC Psychology, 7, 29. Accessed 21 July 2026 at https://pmc.ncbi.nlm.nih.gov/articles/PMC6524213/
