Unconscious bias, which is deeply ingrained and often hard to recognise, impacts decisions in ways we may not realise (Bourdieu, 2001). Implicit bias, shaped by repeated exposure to real-world interactions, also plays a significant role in this phenomenon (Chapman et al, 2013). As such, in health care, intuitive decision-making can be a double-edged sword. It can help during emergencies but can also lead to discrimination and biases, especially in complex situations. In addition, hidden and automatic biases, which are further strengthened by unquestioned repeated practices, have a significant impact on daily healthcare interactions (FitzGerald and Hurst, 2017).
Historically, gynaecology occupied a marginalised position within the realm of surgical care, often relegated to the status of a ‘Cinderella service’. This perception stemmed from societal attitudes and gender biases, which influenced how gynaecological surgeries were viewed in comparison with other surgical specialties. Gynaecology, being predominantly focused on women's reproductive health, was sometimes considered less prestigious or less prioritised than other surgical fields such as orthopaedic surgery or general surgery.
Nowadays, gynaecology is recognised as an essential and specialised field, and gynaecological surgeons are highly skilled professionals who provide vital care to women of all ages, playing a crucial role in diagnosing and treating a broad range of women's health issues, including reproductive health, gynaecological cancers, and complex pelvic conditions. However, the historical context is important to consider when examining practice in the field of surgical care, as perceptions vary depending on the habitus – the values and attitudes – of the working environment. Findings from my PhD study highlighted this, as unconscious biases were uncovered when examining perioperative pain planning practices associated with daycase surgery (Ford, 2020).
Findings highlighted that during preoperative interactions, health professionals' pain discussions and decision-making were influenced by their existing judgements and preconceptions. Day surgery and particularly gynaecological procedures were often minimised and downplayed, and patients were stereotyped in terms of the health professionals' perceptions of the level of pain that the surgery would evoke and thus, were treated unequally. The preoperative information given to patients was at times inadequate, with dismissive language often being used. Female reproductive organs were not associated with high levels of pain, leading to less preparation preoperatively.
‘Gynaecology, being predominantly focused on women's reproductive health, was sometimes considered less prestigious or less prioritised than other surgical fields’
Aranda (2018) agreed that female reproductive organs are by and large unseen, not often associated with death and not often talked about in society. Low prestige is also aligned with conditions that are not linked to specific major organs or are slow to develop, such as endometriosis. This may be a consequence of the cultural worth that is placed on different types of pain, as visceral pain is traditionally taken less seriously than somatic pain and for many years was associated with the term ‘hypochondriac’ (Maybin and Serpeth, 2012). The link between perceived pain and level of trauma was also found in a study by Schreiber et al (2014), who stated that nurses provided more attention to patients who were suffering from more physical signs of injury, such as those found in orthopaedic and general surgical specialties. However, pain is uniquely experienced and attempting to equate individuals' specific pain to certain surgeries and levels of tissue damage could be detrimental to patients' recovery.
Healthcare providers' stereotypical views of patients and their conditions can lead to repetitive practices that limit their ability to consider alternative options. As a result, repetitive processes are viewed as a major factor in limiting habitus. Healthcare systems can be impacted by biases that affect decision-making, especially when such biases are unconscious and not regularly checked through self-reflection. These biases can be particularly challenging for staff in day surgery, as their previously held perceptions of postoperative pain levels may be difficult to change if generated from a narrow viewpoint. Additionally, in busy areas such as perioperative departments, health professionals may forget that the surgery may be routine for them, but it is a significant and non-routine event for the patient.