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on implicit bias. Know there's a lot of training sessions on implicit bias, and a lot of people are king on them. Um, but a lot of the data shows that it's not a lot of change that happens after these types of trainings. Um, I mean, is really in the name because if it's unconscious bias, how do you change someone's unconscious biases? Right, Um, in the idea is that they don't know that they're doing. I think sometimes these actions are very conscious, and you can blame it on just But, um, if it's truly unconscious, I think a lot of times it comes around to learning about, um, different cultures, more cultural sensitivity, more awareness and being able to openly discuss various issues. So I think there's a lot of work that has to be done around analyzing and scrutinizing our social behaviors because some people are well meaning and they don't see that what they're doing is bias, right so that what they're doing is discriminating us others, Um, but I think we have to look more closely at our social behaviors and about unconscious racial stereotypes that plays a huge role in how people are treated. So when is it is in Iraq, with patients or even other colleagues? What? I rolls or West type of stereotypes come to mind while they're engaging other people. And when I talk to students, even when we talk about cultural competency, um, I had them do this debate this year in the year to where they had to say, um, the top it was is cultural competencies necessary to have a positive patient physician interaction. And of course I was like, Yeah, yeah, yeah, you need This unit is okay. Well, yes, cultural compensate is important, but what does that mean? So do you walk into a room and make certain assumptions based on a person? Um, that may be from African back around you, making assumptions about behaviors that they have or how they will follow through with their, um, their medical care. All right, so we have to balance these things. I think that's when we talk about implicit bias. I think that has to be part of the conversation west. The follow through. How do we scrutinize are everyday social behaviors and what are the consequences? I think a lot of times that when we talk about implicit, biased people say, Well, it's unconscious, So I didn't don't know purpose. So there's, like, No possible. It's too it happening, right? I think so is more aware of this. Um, that needs to happen. Yeah, that's my initial thoughts. That capacity to Sierra? Yeah, that's a great like you. Late. I am. So my name's Kira. Um, my partners, she her on the junior doctor and I'm co chair of Glad. So this the, uh, association about to be t q plus doctors and dentists and in the UK on Thank you for having me on. But I think that's a really interesting question, right? Like how we combat especially, you know, on intentional bias. You know, on, I think sort of leaning on for more when it's a said. I think the big things we gotta do is really have a look at who were encouraging and accepting into medical school, because if you've got on, uh, cohort on like, honestly, my medical school in Exeter was 95% white, probably 70% middle class and above, um on, you know, if that's who you're socializing with that so you're like growing up with maturing with learning your medicine with on it's gonna be you're gonna have much less experience of other cultures in a personal and life sucks lifetime way, You know, you you, if you only ever encounter, I don't know Transpedicular are you know, people of Asian heritage or whatever as patients. Then you will never see them the same way. Or it's a lot harder to see them the same way that you do if you actually, you know, if they're your colleagues. Um and I think that one of the good ways of doing it like I mean, it takes a whole institutional shift right is to really, like encourage people of minority backgrounds to be not just in medical school but be like present in medical school. And there's a whole lot of work we need to do to encourage the students to feel comfortable doing that on to give them role models throughout their medical careers. You know, both in the medical school and in the local hospital on Teo just sort of impel themselves on their patients as a as a result. Uh, Depeche, thank you. Thank you for having me and great care for some actually calling their thinking on exactly the same lines. Basically, um, so, yeah, my name's Depeche. I'm GP on pre PhD researcher involved in cancer care. And so the accident may fall into house inequalities. Kind of because I think it's important, but it's not really the main you research interest. Um, so my thoughts around bias, I guess probably the first thing. It's just it gets confused a lot because become very, quite corporatized. Now, um, you know, love institutions do. Let's be bias, and it's removed, bias and stuff. But I mean, bias is just a way off the brain thinking, So you've got your fast system. It will make the automatic assumption you got your So system of the brain that makes takes a bit longer is conscious on. So it's people blame sort of the femhrt spraying that makes assumptions. Basically, what was The next thing is how does it effect people have this affect medicine. So if you look on a person to person interaction, um, it's very hard to detect, all right? I mean, if you come into the clinic, if you ask the patient how they felt afterwards, they would say, probably stomach complete different tell the clinician felt, for example, where they felt they were well treated in the song, and it's very difficult to work out what happens. Well, what is easy to see is the different in patient experience, where you may, where you are slots of patients. So one example would be, let's, say, ethnic minorities and cancer. It, um, we know they don't feel listened to in the UK they don't feel hurt on they don't feel they were treated the same. Basically, um, compared to White Majority, for example, that's that's one thing, I guess the other ways that effects is making a diagnosis. So that's where a lot of the medical literature focuses on about we should, um, you know, different strategies to make diagnosis better, we don't fall into the quick crap. The one trap would be, uh, you know, you got you got distracted. Or you like this patient with a reminder or something, you know, or you don't like this patient so consciously or unconsciously, and therefore make the slightly wrong decision based it being come to the wrong dinosaur. Someone suggested diagnosis like the patient or ah colleagues suggesting be the diagnosis and most the sort of literature around of diagnostic reducing diet office. If I says there isn't very good solution long term or short term on, they say that reflection might help. Yes. The other thing is, I also affects the way we see research researching. Important with that how we move medicine forward. Um and so we we put my prestige to quite large institutions, and we associate it with that, the things like Harvard, Oxford, Cambridge. You know, you see how, for example, on what it means is that we, um certain institutions, especially the global North on in Europe they accumulate a lot of the research funding, which means that automatically places in, for example, Southeast Asia, Africa, the Americas. They don't get the research funding, which means that we've got this pocket off where only a certain Pete set amount. People with a certain set of ideas get research done because it matters to them on Has I, Doctor great. Quite, quite well pointed out. That tends to be people from a certain demographic, which means that we don't target helps inequalities. Very well. Um, and then I guess it's sort of solutions, isn't it? And I think that's courage. Touched a Z Well, about cultural compensate. It's a tricky one because, you know, you risk. You know, we're just getting people to do one of training. It's just love it because you do an hour and you're done, and then you're done thinking, which is never great. Um, And then, you know, you risk there typing. Um And then, of course, if you're thinking about asking my nurses which probably what I've seen in the research, it sort of suggests that we've got this sort of Eurocentric, and then everyone else is over, which is no, not particularly helpful if you're gonna try improve health inequality. Um and so one of the concepts we'd be looking at was beyond competency. What we call safety. Don't worry. I'm gonna wind up in a second. I know you want to get some questions in, but they called cultural safety, which is a concept from, um, You Zealand is about patients. If they don't feel the service is safe enough for me, they should feel safe enough to walk away on. It's about negotiate, giving them the power basically to feel on to be listened. Teo, in that conversation. Um, and ultimately downstream. Think it's kind of worked up Career was talking about procreation. That is where we're going to get better healthcare services when we are selecting people who are more represent work for communities. Um, a representative people, possibly from ethnic minority. That would have to be. We do get strong advocates for outside, but I did It would be on. Then we can co create healthcare services and research on institutional change that therefore will effect on DCI ain't the way we do practice and then we'll change education and clinical work for you. Well, twice a day, I think you have one of the initial forth. Does anyone have any questions? They want to pay you? So a palace right now, neighbor, post them in the chapter of you're comfortable with telling on you Mike and asking questions Now. If not, then I guess we can get into our first question that we got already. Which was, um how would you define implicit by us? And when that's a good thing, we don't understand. Take forever to, um, eat myself there. Yes, So when we talk about implicit bias or unconscious bias is about the bias that happens, where is supposed to be unintentional or you're not aware that this is happening and racial, um, biases among physicians or something that recent studies suggests that, um, for example, black skin access to healthcare systems. They're less likely than wise to receive starting surgeries or certain type of therapies. So it's kind of example of bias. So cause the assumption is that even though and they've seen it, they've tested this. That biases may represent over, um, prejudice of on the part of position, but more likely to use the subconscious perception. So I or stay all types rather than deliberate action. So these about subconscious biases that occur, um, to towards a patient from are certain group and one of the really clear points in the data that shows like, who gets, um, organ transplants? Right? So there are certain assumptions that are made that people from infant minority background will not follow postoperative care. They're not gonna have the resource is to keep up with the things that they should or go to starting therapy is they need to go to posts. Um, the transplant, and sometimes they are denied that based on those assumptions. So that's kind of examples of subconscious bias. Is unconscious bias this whole? I've been trained to look at it. I think there's also a n'importe distinction for clinicians between what's a conscious assessment of your patient on their risk factors based on what you know of them or what's, you know, an unconscious bias because you know, you would be failing a patient if you had, you know, a refugee from Somalia or something who was pregnant, Come in on. You didn't consider whether HIV, you know, was was a possibility that you're failing that patient. But it's about whether you've looked at that patient on dysesthesia, um on had reached this conclusion or whether you've just gone this'll person's African or what if they've got HIV, which unfortunately, is actually what I mean? Ah, a lot of medical institutions tend to kind of do you see a lot in exams where it only trip? If your question says this patient's from Africa, chances are they haven't HIV diagnosis, which you know, and that's just completely not fair because, you know, at the end of the day, ultimately your patient from Africa, it's just like you have heart failure or, you know, COPD or any other diagnosis. Is there anybody else might have? Um, Andi Yeah. You do need to consider these potential, you know, issues. Um uh, you know, it's established that people of like, ah, black African heritage have a slightly different pattern or renal failure than the white people do. And that's important for you to know, because you need to know how to treat it. But it's making sure that you don't make you know this is a conscious thought about your individual patient who is in front of you and their risk factors are not just, you know, um, implicit biases. Grenet was talking about living. Can I step? Can I jump in Requip? Yeah. Okay. Yeah. Based on what Doctor Green was saying that I mean and that's true. It's like what? You have to look at the patient in front of you And what What is their case? You know what their their charts tell you? What are they telling you? Listen to what the patient is telling you rather than making certain assumptions. And I think that even some of the medical training, um, saying that certain people are affected differently by certain things. When you say you label black such a huge category, um, just can't assume right. You have to look at the data from the patient that's in front of you because a lot of assumptions are made about people from South Africa, Um, South Asian, um, just, uh, areas because they assume that, Okay, they have my levels. Type two diabetes. Certainly these may be connected, right? So to make assumptions based on what the data shows that maybe more prevalent in certain cruise first, another set of Listen to what? The patient telling you What is the case with this patient? Are they you know, do they exhibit these type of symptoms? You know, instead of making assumptions, I think that a lot of times people get in trouble for basis, you know, looking assumptions, even when you talk about, um, like sickle cell anemia, we notice more prevalent in some areas versus another. But it's also this idea that is not impossible to happen in other areas. Another culture is I in other ethnicities. So you can't like this on it because okay, showing these symptoms. But they're not African, So maybe can't be sickle cell, right? Well, like look at what? The data showing you. I think that a lot of the times, um, things biases come in because they even when you have cultural, competent training, right. And you thought you have certain sensitivities, Like, what does that crossover into creating the stereotype versus, like, assessing the patient? I think you're spot on doctor career with that. Yeah. I mean, I was going to say that. I mean, we talked about so biased. Like everything I said before is like the operating system, the brain. So, you know, you got your fast and slow brain and you can't she deletes operating system because then it just won't work. Oh, I got a D by the system. It's quite hard to sort of remove something that's so critical to human, probably human evolution. Um, for us to recognize he's inside are in group before he's not really relevant anymore. Because they look or don't look like us, um, or to like spot predators. And when it comes to we're looking at, so helps inequality and ethnic minorities. I guess the issue is that when we stereotype also I don't know how this happened the medicine, but we seem that's a biological or genetic thing. So if we assume, uh, a certain member or button exam very green tea is they would like to be talked to diabetic. A lot of people assume that's biological genetic, and so you can't do anything about it so they don't even know what for them. Treatment options? Um, don't think more widely. And then also, it's a double dose of it because in the community are sort of like, Well, it's genetic. So I didn't think about it. I'm going to do anything. I'm gonna change anything. I don't think my lifestyle it is what it is. And it's going to take all the medication of the doc says, That's I probably No, no, the greatest thing so tricky, Tricky. I think we still we went way up the track of them. The question was, is a visit, but it's anyway, dress it. Hi, I'm Erica. I'm also from all much I'm just taking over for Joseph or bit, um, I also wanted to ask. So this has all been thinking also quite a bit off How, from an institutional point of view, there's implicit bias but I was just wondering if any of you have any advice for what we, as individuals can do to sort of recognize these unconscious bias is on dialysis them in ourselves to give that to care for patients and also to be more, um, inclusive towards our colleagues as well. Okay, I think Depeche ESIs or Doctor Gopal. Sorry, I don't mean to this disrespect your, uh, on your, um following worry. Yeah, I think he's made you know, some really good points on this So far. That is very much. It's no, you know, we can't fix on Contrave I It's is like that, You know, Um um one of the things I find myself trying to say is sometimes I feel I'm a little bit like my mom and I'll walk past. Somebody would be like, Oh, my God, Like up? It's just such an awful outfit. Like, why did they choose that? And then I'm like here, you know? Where did that come from? You know, and you just go when you just gonna try. And I I think I think this is what depression is trying to say. It's just try and be aware I'm trying reflect on what's coming. And I you know, you just got to try and check yourself. And the more you might be able to, you know, not be able to stop yourself thinking something in the first place. But if you long as you try and, you know, stop it from becoming something that then affect your practice on your question, you know we're okay. Where has this come from? Why am I thinking this on? I think it, you know, it works across the board. I'm not gather. Yeah, I think that's I think that's a great point. And I think that, you know, sometimes, you know, doctor Ear, you You mentioned that the beginning in medical school. What are you exposed to? Who are you around? All right. And if you don't experience any other cultures and see, you know, the people from different backgrounds, you know, you don't have exposure to it. Um, it's one of those things, and I'm kind of Yes, this is like contact the reason you have more contact with minorities. Certainly you're on the stand up, but it's like you don't have to necessarily have the person for you to understand or the field they're paying because it's like a lot of times we have different sessions when they have people from target groups. Oh, tell me what it was like to be a woman in this and that, or to be black and this, you know, looking at what I call a charm a porn. And it's like everybody's like looking to absorb. Like, Okay, this is what happened to this person. Let me not be on. Let me not be the person to if, like, certain pain on people, Right. But everyone knows how to treat someone properly, right? You know how you want to be treated right. And that's ultimately is about reflecting on. Are you treating other people? Regardless of the race, ethnicity, other characteristics, How you want to treat it, right? Are you letting you know? Are you making certain assumptions about said group negatively impact how you may treat the group? All right. And I think I mean, it's something I can't change overnight, but it is something you should be aware of. Um, something to be more conscious. Um, and I think that sometimes you don't know what you don't know. I understand that but you have to have a really conversation, um, with yourself and understanding that, you know, what do I know about other groups and my accepting of other cultures? Why, you know, people dress certain ways because this is, you know, cultural thing, right? Um, yeah. And then don't let that negatively impact how you would treat a patient. And I think is, you know, one of those things. If you're not exposed to anybody that doesn't look like you or doesn't you know, live the same life? If you think that sometimes in medical school you may be around a bunch of people that are from a privileged area or privilege lifestyle and it's challenging, understand the other side. We talk about social determinants of health. I think that's gonna That's a huge part of it. To understand how society impacts, you know, shapes of health outcomes. I'm a social, social science. Is that hard on my, uh, medical sociologists, my PhD's? And so I'm constantly looking at how society impact health. It's not for as the individual behavior, this is outcome. It's structural institutional issues. And we were talking about how could we change medical school? I think that is gonna be incorporating more understanding of how social structures and institutions impact people's health and understand our own biases within the society. I mean, I was gonna say something like a current, um, tools in in the armory should we say we talked about implicit biases, implicit bars, testing and training work. So you still have these one? Our Our sections, which are given often glance situations with, Well, meeting can change some impressive bias. But the problem is, is it's You can't measure it so you can measure it with an actual test. I'll put these things on the chat basically, and you can measure it in a using implicit about bias testing from from Harvard but not completely sure what that means. And then, of course, if you test something like and everything in medicine, what's the treatment, right. So what is the treatment? So you know, if someone is virus, what we want them to do, so we need to Really a lot of it is just like just ruminating like rumination to do anything. So, you know, what are we going to give you? We're going to give him a whole two oh, things they can do to try and change their own bias is we want them to read, reflect on their practice to win. What do we want to mandate that? What? The evidences of mandate retesting and, uh uh, testing and so training shall we say on. But there is a really good data to stray that the testing does nothing all the abstract. Is that good enough to decrease biases? Um, looking in America, they still 40 speaking in l. A. I think before hand. Um, and there was so forcing this on doctors and lawyers. But then I thought, if you're forced in them, what you're going to change um, and part of it, probably changing bars is basically what they were. Doctor, granddaughter, Caribbean say look in the mirror and see what kind of person you are. Now, in essence, very technological, social media age. It's a lot about open facades basically and gone looking. So where especially interactions it didn't turn a work of looking inside of realizing I'm gonna be a good pass it I said this. I thought this, um, I good person. No one really wants to do that. We would like to be the hero on stories. Don't wait. So you're going to take a little bit of time for people to try and think about that. You know that you are so on who might be prejudiced against this group. Or, you know, you might be judgmental. It's know about labeling people is getting people to think. Oh, okay. Maybe I just need to be able to internal work. Maybe I should think about what it's like being them because we have no idea what they're Even if we think we know people, we have no idea, really What's going on device? I mean, we see Even if your best friend, the family, you're not sitting in their brain, you have no idea they're going through probably quite a lot. And so, yeah, we should look to see how well it it's a bit like the first week I put in is about working problems is to multifaceted. We shouldn't for one solution, but we should look at what we got in the armory. Basically, try any things. We need a decent evidence base. Lots of different things in the armory will work. Did you get people to change? But I think I think he just bright, I think because generations are coming through our more open to this. I feel, um, to think more critically about who they are, what they want from silently and better things for society, not saying the previous generation haven't. But sometimes when confronted with such data that sometimes is a bit more resistance than you expect. I'm going out. Yeah, thank you for your responses on that, I think in, like keeping with this theme. I think we've mentioned sort of about the mega medical curriculum on. I was just wondering, What's your thoughts on? So what progress we've already made, like, What do you think is good? But in the changes that already there and what more might be needed, Teo probably address this problem. So that's something I try and work on a lot of sweat. A lot of work with the medical students, medical schools, um, part that for me is representing the OJ be to keep less community. It's no, um, always a visible community, eso like, you know, for the most part, if if you have dark skin like people can see that people will make assumptions based off that immediately looking at you. Keep away. What? We almost have the opposite problem in the LGBT community where people will assume that you are straight and cyst until told otherwise. Um and so we have this, like, fight off trying to actually be recognized on people, even even knowing that, you know, they have LGBT patients and that the there are to be two status maybe relevant to their healthcare. Um, Andi. So I do a lot, you know, for me, just teaching the students on G B t health inequality in general. If the first step and I think you can see in the last few years more and more medical students, medical schools rather inviting us to talk on or developing their own on curriculum, which is, I think, a massive step armed. Hopefully over the next few years, we can really sort of developed on that. I think we have to be careful that we're not expecting things to be fixed overnight. You know, one of the things with implicit bias is is that you know, as we've all been trying to say, you don't wake up one day. Go see, You know, go do one of these implicit buyers tests and then be like, Well, let's make your you know, it's it's a process. We gotta work other society we have to work on, but only slowly but surely what we get get through this on. I think we need to consciously try and make an effort to address it as well. Um, with these sorts of inequalities, they know that if you know, yes, progress is trickling in the right direction. But that trickle won't become anything meaningful if we don't try and help it along. Yeah, I can say, um, in the medical students where I'm teaching at University tomorrow, we've tried to, um, instead of being like one week on this particular issue, or this various groups, we try to embedded in the training from year one all the way through. So it's always a part of the units part of the Converse Station. It becomes a normal thing to discuss is of inequalities. And how does this shape? You know what we're discussing in the social ethical aspects of medicine? So it's not something that students will get one time. It's going to be a constant conversation, something for them to think about throughout their training, starting a year one rather than this one week during year to where you talk about inequalities and that's that. So that's some of the work that's being done. Um, we also was giving a pee test grant where we're looking at, you know, all the efforts around decolonize in the curriculum. And so we're actually interviewing medical students as well as the professors to talk about. Their experience is in medical school, around the inclusiveness of the curricula. Um, across the board. All right, how did the professors feel about teachings? That materials did, um, materials that actually represent various groups across the globe. Um, and from a student perspective, do they feel included? I feel that they're heard on. Are they, um, you know, other issues that need to be addressed. So that's come some of the work that we're doing right now, a lot of it, Like if you're thinking about making change, a crick in level. Yes. I think what's really important is that we look at it medicine. Looking back at it. History when How is that relevant? Today? Um know, sort of like not meant to be like medicines. Time in court. Right, Um, but to understand where the knowledge is come from and some of the terrible things that have to have been sacrificed, um, into occluding marginalization or, you know, I'm not talking about racial equality is, you know, I'm talking about, you know, terrible things took, you know, with regards to conversion therapy. And you know, the use off, um, off abortion, um, therapy. You know, it's come for a pretty dark place from what we call is, like, what? What we call the normal medical What we call whatever normal medical care is right. So has been huge human sacrifice that's been required to get to this point. And sometimes what happens is is that those histories play out and really life because people feel that those haven't really been addressed and they don't feel it's safe. Now. It's got a system in any way. Um and that sort of doubles down on access because we're not, We know, acknowledging what's happened in the past which may or may not be relevant for the patient's sitting in front of you. But we need to be mindful about on I think what sort of coming through with decolonization is that That should just be a normal part of history. Medicine should just be some random degree. You know, we should It should just be part of new medicine and go again. I what? These people would treat a terrible, you know, and, you know, they suffer such terrible things. And this is what's happening now. Well, you know, I asked the students, What do you think should be done? I'm you know, I would say I think the other thing that should be sort of no mandate. It would just be, um, just outreach products in the community with people who are marginalized and isn't matter which which whichever community that is. What about, you know, could be a women's refuge. Could just be, um you know, any charity, whatever is, you know, wherever is I think it's just should be part of it. Make quick. Um um getting them to really think about some challenge of the people face and how the increase of the bypass them and work with the communities. The only issue with being so adventurous is everything is about traders, right? Same medicine. You put something in what is coming out that's what? You're every educated. Well, you know, you bring this up and say, Oh, that's really good But what you want to be thrown out out of the time? Look at the time is short, and that's our conversation, isn't it? You got five years and it's still enough is it is. So whether you know, the outreach products are, um, part of the research part of degree. And maybe the history of medicine is a slide on every specialty somewhere asking us We know what's happened and where they where the history of that thing is coming from in relation to how center qualities and now a step forward. Basically, I think just depressed show, you know, you just reminded me of something that I think is it'll. Bugbear of mine is when I'm invited to talk to medical students and they'll say that the session isn't mandatory. Onda, like I love everybody who comes to it fantastic for them. You know, I will take that opportunity, but it's almost a self selecting population is. But you know, especially for me with my LGBT inequalities, the only people that turned up to that are the ones that already kind of care about your GPT issues on D, you mean? Yeah, Okay. I'm probably never going to reach somebody who's a raging home a folk, but it's the people who just, you know, probably well intentioned, don't have any issue with LGBT. Put it's g b t people, but just don't realize what you know. The importance of it is a subject in the field who don't come that, you know, I actually think could move benefit from from attending that kind of session. Right? Honestly, I I always think about, you know, if you're gonna commute the dial, those people are converted as people in the middle. You're open to listening as people who will know they might turn up of his mandated, but they won't change. There's no way in how their views of cemented they made their mind up. This is not relevant to them. So I will walk about them. It's just too much to deal with. One's already converted. They're they're already the other. People will say there are sort of often and we open to that change. And there, there So I will worry. We can't change everyone. I think you're right. It's you know they're going to be self is like the people that are already gonna be interested, Already sensitive to the issue that you have the people in the middle, I think the people in the middle, the one you can get the most out of it, right, The people that are on the other side of it, totally against it. Yeah, I've learned through many conversations it is a waste of absolutely time. But I think that, um I think there's something to be said about making it mandatory to get a higher level of engagement. I think that sometimes when they know they're not going to be assessed on something, it's like although this is nice, but I'm not gonna fully invest because clearly, this is not gonna be something that shakes my, you know, career. And I think that yeah, those are conversation that we've actually had around, like, suck. Should these things we mandatory should have assessment connected to you know, these these areas and, um yeah, but yeah, you're never going to reach some group. You never get 100% but I think the people in the middle willing to shift. I think that's gonna be where most of the benefits one of the things that, like I try and point out to the people in the medical school with with the authority, you'll learn all sorts of stuff in medical school. You know, you'll learn about all these rare conditions you'll learn about, like, even even stuff that's moderately common. But I will tell you you will make more LGBT people in your life the new wills patients with cystic fibrosis right on unless you're working unless you're in a CF clinic. But, um so but the fact you know this is put this isn't considered a priority for people that actually, you know, people off minorities are globally that my job majority even in the UK if you had piled everybody together that what that had a minority status in some way, they would out they would completely over number. The majority are certainly the majority who have the power A Z well, so I think it's really important. Um, that stuff gets talked about and that it is, you know, by making these things non mandatory. There is an implication that it's not important as well. Yes, I see you have a message here saying exactly that. Yeah, that doesn't the message of not magically imply, not important on I think that is, that is very treated. It is even, you know, as a card medical student, I can say that a lot of people just don't go to you non mandatory things. And then the importance of it is just completely missed. Assume, um, to change the topic. Slighty. I was wondering if we could shift Sort of. So we've been speaking about the the future generations off doctors. What if we're thinking about current doctors now? I was wondering if you have any experiences off implicit bias in the workplace with colleagues on sort of how how to challenge that and how Teo, you know, try it, make a difference for people who might not have, you know, already recognized these problems. Well, I well, depression. Did you want to ask you this Because I don't work in a clinic or anything? Oh, I was just going to say that I have done sessions for in a chest Scotland as well as in the tests England talking about various issues around Rachael inequalities and biases. And I think that those sessions are important because it's through their education sector. And so it's about increasing the education of the physicians and making them more aware of, You know, these issues. And I think it's I've always got a lot of really good questions, right? People that are actually just interested. They just don't have a clue or didn't know certain things existed. I didn't understand, but, uh, yeah, so you know, I think including more of those sessions, I think those are beneficial for the physicians. And I think that, um, the race, um, absorb it, Torrey, that they have going on. I think that's a lot of that's a huge effort is going on right now. That's that could be helpful. So I mean, those are some helpful things that are happening. I think I think I think when it comes to serve you well, so ill time to really judged assumptions where that's from colleagues or patients. I think it's sort of quite delicate, isn't it, because you have to work with these people on with that. I know it's cool eagle or patient, especially kind working primary cameras. You know, several Your relationship is an old is no It's not a one of clinic. They're gonna be back in clinic at some point. Seeing someone, of course, that is their care is important. I suppose if you if you feel that it is an assumption on it's really judged on it, probably offensive. The easiest way is to actually is just questioned then. So it's like I'm sure it doesn't happen as much, so I think it does. But I'm not sure about the exactly. It's it's own case. That's exactly something that you're kind would say. So you'd say what you mean You're kind, which kind? Oh, you're kind, You know what I mean? I don't know. Sorry, I don't really understand what you're kind of so just tactfully probe on. Just keep probing basically, until they sort of realize what's happened. You don't It doesn't have to be offensive. That's just genuinely curious teething, right? You know your job is not to humiliate them, but it's just to get them to think. And you contractually do it without, you know, making you feel that they're kind of in his health care again, or they can't end of the your colleague. It just gets them to think um, about the Donald Exactly broke. It's a tricky one, I guess. And but the other one is instead of Microaggressions, which sort of gets it's all floats around when you talk about these sort of things, which are just, I don't know, I'm sort of trying to listen to use. I don't necessarily agree with my nose. It's a wonder. So you say politically right of the spectrum. Should we say the conservative, they sort of say, Oh, you're trying to release my speech on then those on the left I said, How dare you offend me? You cannot say this to me is offensive, which is really ridiculous. Oversee answers already land somewhere in between. I just find it really hard because it suppose if you gave me polestar these are things that are friend. People don't ever talk to them about these things. You kind of risk the gap in house chemical to just being so wide, because then there's no Darlow ever right. But then there's also a big way say, Well, you know what? You can't drop the n word, right? You can't do that. You can cause on the P where you just drop these These, like slash know, appropriate. Say it's a hard one. It's a hard one. But there is stuff that's clearly events of in a line that can't be crossed for, you know, gracious labs. And then we'll fix that. You know, appropriate on are offensive cannot be talked about. But there's something growing so feels could be a little bit casual. And it's over step of the time, which I think we should just gently probe. But if there's been a line that's been crossed? Absolutely. I think if you're the medical student, Judy Doctor and you don't feel comfortable scenario, um, tackling head on, just asking them about what do you buy that would do you feel think is appropriate to use that? What? Well, what do you mean, rather just keep propria. But if you don't feel comfortable doing that, just talk to your boss. And if you think the consultation trust is being severed, for whatever reason I mention it from a patient towards you, then you don't have a You don't have to see that patient actually having obviously life's reading things aside, but it's a click thing that you should ask for senior support they should back you up really as well. That's something I'm Depeche, that I'm. I always try and highlight, like in any way. You know whether whatever background it's coming from, whether it's homophobic, racist, Islamophobic, whatever, you do not have to treat that patient, Um, like there will unless you are in. And, you know, unless you are the only consultant in hands or something, there is essentially no scenario where you will be the only person able to treat that patient. Um, Andi, you can. You should always be supported to remove yourself from my situation if you feel appropriate. But also, you know, we can refuse to treat patients assuming they have capacity. That's the only caveat if they insist on being racist. Homophobia, whatever you know, be a homophobe or racist. Abuse is considered a hate crime. This is a crime. The police come get involved. It does not have to be physical on on. Obviously, you know, we would rather not get the police involved if you know, if you don't like, if you can avoid it. But you can. And I have heard off trust that have literally just been like you either need to, like, stop or leave or call the place. We're not treating you any further because of your behavior. Um, like, you know that that that does depend on your trust supporting you. But that is an option. Um, I think, um, some your has made a good point in the comments about active bystanders training, helping with it all of these. But as the passion said it, the that there's a line that is obviously inappropriate. It's the stuff under the line that's hard to deal with. Um, Andi, I kind of do something similar when people make is sort of, you know, slightly judgmental comments or never right there. You know, I wouldn't necessarily always question it, but say it was like, Oh, well, you know, like you would surely know about this on then I would just, like intentionally miss interpret that on, say something along the lines of like, Oh, is it going to Jackson? I wasn't aware of that being a stereotype, and everybody kind of sounds and being like, Oh, the That's not what I meant it all on that. Yes, that's maybe in a bit cheeky, and obviously it's not always appropriate because you could potentially alienate a patient, But sometimes I just will because, you know, you know, like I think sometimes you've got to put that jar into the person's thought stream for them to kind of backtrack in their head and think, Wait, what? What was it that I said that was inappropriate? I'm not necessarily inappropriate. But like I made that assumption, why did I make that assumption? I think on the important thing as well is that you should support your colleagues. Um, so you know, it's not just on somebody to defend themselves, but equally, I think it's important for you to know what your colleagues get to know them on. Find out what kind of support they want, because sometimes people don't want you stepping in. Sometimes they would prefer to deal with it themselves on maybe by you step in and you're actually making it more comfortable for them or you're making them feel less less empowered on does why it's important to know who your colleagues are and what what they want. And sometimes all you need to do you know, you might not necessarily have to, you know, stand up and get into an argument with a patient or a or a consultant about it. But if you be, you know, small things, like making eye contact with your colleague and sort of suggesting, like, Are you okay or, you know, just little chats. Checking up with them afterwards makes a huge difference to that individual. Um, I'm just trying to stand by the Yes. I'm sorry. I mentioned times there, and you might not, though, Um Oh, what is, um, the only thing I wanted to see other. Also, to stay on that is sort of Lincoln. Back to the original question Erica had asked about whether it's seen, um, these kind of situations in real life. I mean, I've seen some really weird stuff. Set it. You know, I've seen one of my friends was told that what has medical students? The consultant made some comments about gays on. He was not well, What do you mean? You know, he's like, Oh, you're not gay, are you? And he decided to make things. I'm going to move like Well, actually on by on this consultants response was, uh how old were you when you knew you were a sex addict? Like you know there's things that are completely inappropriate, but there's a lot of other things that are harder to deal with that. So in the LGBT community, there's these assumptions made a lot of the time about somebody's personal life on show, for example, Easter Christmas, other bank holidays. It's almost assumed that this gay person can work those shifts because they don't have a family or kids to look after. On. This is something that crops up quite a lot when you know when we talk to, um, our our GI Bt colleagues. And it could be hard to kind of address because there's no, you know, it's no intentioned on it's no, you know, something that you can really complain about unless it's like repeated, and you told the multiple times, which is, you know, almost like harassment. But how do you How do you balance that back? How do you deal with that from your seniors or your right equipment or whatever? It could be really hard. Yes, thank you all for your comments on that. I think that was really helpful on, um, also the mention off the active bystander training. I've myself done that with the university. And I think that's also really helpful to just give, um, almost more tax full ways to try and navigate these situations. So thank you very much. I think that's really helped. Um, we have about seven minutes left, so I'm just gonna look for our last question. Um, so I'm just looking through all question list? Um, yeah, I just wanted to ask. In general. So are there any things that he would like to summarize about implicit violence on how we can You're just sort of try and incorporate this into and all practices one day, The only thing I wanted to add about interested buyers that we haven't really addressed yet. It's not as if me as a queer person. It's not as if I am, um, immuned to implicit bias against my own community. Uh, I think that's something that's really important. Is that you know, these social stereotypes andare concepts are so widespread, and some of them are so deeply embedded in our cultural consciousness that we don't even realize they are Syria types or biases and, of course, were affected by them ourselves. So, you know, I can still make assumptions about trans people or gay people, even other queer women on. It's important to know that, uh, I think it's also important to know that your patients are individuals, Um, sounds it, you know, actually, there is all sorts of different subgroups within every community. So lesbians, other community are actually very different from day game N um, on a lot of ways, there's no cross over there, but people love percent under the same community. Um, which, like, I'm sure that this happens a lot. Um um where somebody would say all this person's Asian. So they must be like these other Asian people I have that, uh, like, that's obviously not true. And like, actually, just because somebody is from the exact same country or town as this other person you've met that you get only well with, you know, they as an individual might not be like that at all. So, uh, it'll links back to what we said earlier because you've got to treat that patient as an individual. Um on may be also be aware that the people it's getting better, but the people who are in power, who are in authority and that we're aware off, even if they're from a minority, often almost get into that position by conforming to the majority to some degree. So other women I could say that one of the famous examples is, um, Margaret Thatcher, and even to some extent, Theresa may They are both women that got into power by becoming more masculine. Um, on. So just be aware that the exposure you have to certain minority groups may know, actually, you know, represent the minority groups in your practice or or in other areas. I'm not stuck me down, so thank you all for inviting me and I think got better. And depressions been fantastic here in your input as well. Well, thank you. Great from here. Use well here for you as well. Um, yeah, and and I'm a bit different because I'm in the academy, but, um, I worked with healthcare providers and future doctors and, you know, coming from the States where we openly talk about this a lot, I think that in the UK, this is becoming a conversation, and more recently, everything's like now becoming an issue, even though it's been the issue for decades. And, um, I think the we do have opportunity here where people are being open to talking about issues of unconscious bias and also racial inequalities. I think that, um, so many things that I think the culture compensate training even though it could be problematic. I think it is important to increase ultrawear nous and sensitivity and talking to cost, um, cross cultural communications and things like that. Um, I think that's something that could be done in healthcare. So monitoring patterns of care and identify and eliminating unconscious bias when you see that if you have ah, a representative number of, let's say issues with people from a certain group versus not you don't have to kind of dig into that and see, like, What's happening? Why is this one physician, you know, not putting this person on to a specialist when they should be like what's happening there and also increasing the adversity every three level of healthcare services. I think that it's going to be huge. I think the only in medical school training also at, um, you know, junior doctor, seeing your doctor all the way up, I think it's gonna important have a presentation across the board. I think that um, you're spot on in terms of like, the people that make the decisions clearly represent a certain group. And, um, just because they have, you know, black or brown skin doesn't mean they actually understand the issues within the group. And I think that, um that could be seeing among among a lot of people that's in power and, um, across the UK So, yeah, there's a lot of work to be done. I think we increased representation and understand have higher levels of culture sensitivity that could be beneficial. Yeah, and that's me. Thanks for inviting me today. It's been great. Things are going to be, um, I love this panel. It's been really good, really great. Hear from us. They are in good at that. What do I close with heart? Avoid such pretty experts on, I think, I think, Yeah, we can't rely on a riot on implicit by straining to cure everything. It's much more difficult than that. What we need to people to do you want to use testing or training is to get people to look within themselves and take that uncomfortable look at who they are. Well, there are some star where they come from, but we're really going to get changed. Yeah, I agree with you. What we call the two differences are equality over tune to us, equality of outcome, which is basically probably most difficult question of our time. So what do I mean by that? So giving everyone the same opportunity where know everyone has the same opportunity in life, right? Versus giving people the opportunity directly. So that's what it'll mouth is quotas. So people people that from ethnic minority or whichever minority background it's given quote, they fulfill the quoted to make that organization initiative more diverse. Now, yeah, this is really, really tricky if they are low side, because you can fulfill that those quotas. But you may not get in the outcome. And the reason is because you have focused on a defined count, risk it and your su that have the same values. You You could say that this current government is probably most diverse that ever bean. If you look at the policy, is there an acting tours, migrants, refugees? Minus the last few months? You would say this is very bizarre. This is in Congress with what you'd expect doesn't make any sense whatsoever. What's happened? So what's the conclusion idea? We need to look within ourselves. But the most important thing is that we dream people around us can't share or values. And make sure by looking in words are values are the right ones that you want to engender a society basically eso it's internal work, but also looking at the radios or everyone around us. And that's why we're going to get some sort of change and have that you need to have those debates, don't we? Question is, where do those debates occur? Often those are my knowledge. I've often it's there, it's on their shoulders and it's unpaid work, which is perfectly sound. So what are the space is that anything you took her should mandate them. I think the easiest way is having an open forum. Basically where these are discussed, where people could feel safe on online environment isn't always the safest. Sorry. Tricky. So, actually, lots of food. Thank you so much for coming today. I really appreciate that. And I think we all are well, Mitch. Yeah, I just wanted to thank you for coming and for raising all of these good points. I think that was a wonderful discussion that we've had today on. Then I just wanted to let everyone else know that we're just having are closing remarks now in the main room. So if people want to just head over there, But just thank you again so much for coming and joining us today. Okay. Thank you, but thank you. Brunch.