Addressing bias in healthcare to improve patient experience

It may – or may not – come as a shock to learn that patients often defer seeking medical help because of the perceived stigma attached to their condition but small, deliberate changes can make a big difference, creating more open, inclusive consultations

When I first became an ambassador for a campaign to reduce bias in healthcare, I thought that I already had a pretty good understanding of what stigma looked like for patients. But listening to the stories shared throughout the campaign, including hearing the stories of five people who have experienced significant bias due to their health condition, changed my view completely. Many spoke about facing judgement in their workplaces, social circles and communities – experiences that can affect how confident they feel when speaking to clinicians.

In my own consultations, I began paying more attention to hesitations in patients’ answers, recognising they weren’t speaking freely. The quick apology for smoking, the flash of guilt that passed their face when they spoke of their alcohol consumption, or the uncertainty some mothers express when reflecting on premature birth and wondering if they could have done something differently. These moments reminded me that stigma isn’t always spoken about - but it is deeply felt.

Chiesi UK and Ireland’s Look Beyond the Bias campaign shines a light on an often-invisible barrier. According to Chiesi’s survey of more than 1,000 people living with chronic or rare conditions, 70% said they had experienced stigma, judgement or blame due to their health condition, with these experiences often occurring both in everyday life and within healthcare settings. Within healthcare specifically, 43% said they had experienced stigma – a figure that rises to 50% among those with chronic obstructive pulmonary disease (COPD).

Concerningly, more than half (57%) reported delaying or avoiding seeking medical care as a result of stigma, while 79% admitted to downplaying the impact of their condition, and 71% avoided being open about it altogether. When patients feel unable to be honest about the true impact of their condition, clinicians don’t get the whole story – which can directly affect care decisions, early intervention opportunities and ultimately, patient outcomes. It’s striking to think that the bias people feel, from many different parts of their lives, can prevent them from seeking our care and being fully open when they do.

As a nurse, I think these findings are a call to action for us all. The people who most need our help may also be the least likely to ask for it. Every interaction, whether during an asthma review, blood pressure check or postnatal appointment, is an opportunity to break down those barriers and make sure every patient feels welcome, supported and understood.

HOW STIGMA SHAPES BEHAVIOUR AND ACCESS

In clinic, I see every day how stigma shapes behaviour. Some patients minimise their symptoms or wait until they’re in crisis before seeking help. In respiratory care, that can often extend to people living with conditions like COPD believing their condition is ‘self-inflicted’ because of the link to smoking. I’ve even heard the words ‘I don’t want to waste your time, I brought this on myself’.

Culture and environment shape health behaviours far more than we sometimes acknowledge. We’re all products of the world we live in – one where it’s cheaper and quicker to grab processed food than prepare something fresh, where long working hours limit rest and exercise, and where constant public commentary makes people feel judged for their health. When we recognise that, we shift our focus from blame to understanding.

The ripple effects of stigma are real: guilt, shame and fear lead people to delay care, withhold information, or disengage from reviews and screening.

FROM INSIGHT TO ACTION – SO WHAT CAN NURSES DO?

Small, deliberate changes can make a big difference. The following are strategies that have helped me and my team to create more open, inclusive consultations.

Start with self-awareness

Bias is part of being human – it’s not about blaming yourself or others, what matters is recognising and acting on it. I build a quick micro-reflection into my day, especially after challenging conversations. Did my language sound like blame? Did I assume why someone didn’t attend? Did I speak differently to someone who smokes than to someone who doesn’t? Those tiny moments of reflection help me reset before the next patient.

If your practice has access to Equality, Diversity and Inclusion (EDI) learning, encourage the team to use it. Even a short session can provide a shared vocabulary and safe ways to talk about what we’re noticing across different cultures. Sometimes, the way you approach a patient from one culture just won’t work the same way with another.

Make it about the person, not the health condition

I now begin most reviews with one simple question: ‘When it comes to your health, what matters most to you? Locally, the most common answer is, ‘I want to walk the dog without stopping.’ Others say, ‘I want to keep up with my grandkids’, ‘ I’d love to travel again’, or ‘I just want to get back to work.’

When I connect a care plan to that goal, the consultation changes. Inhaler technique becomes, ‘Let’s tune this so your holiday isn’t off the table.’ Another discussion can be about feeling strong enough to return to hobbies. It shifts the tone from instruction to collaboration and helps people see that we’re working with them, not judging them.

Reframe the conversation

A lot of bias is carried in small phrases. Slight tweaks to our language can be a practical way of making care more approachable. For example, ‘You have missed your review again’ becomes ‘When is a good time for you to come in?’

Normalising the topic helps too. I sometimes say, ‘We know from national research that lots of people have felt judged when talking about their health. Has that ever happened to you?’ It gives them permission to share experiences that might otherwise stay hidden.

Proactive and flexible outreach

If 57% of people say they avoid or delay care because of fear of judgement, we should also consider that waiting for them to come to us is potentially missing a significant cohort of patients who need our help. Where possible, proactive outreach can be very helpful in dismantling perceived barriers. That can be as simple as a short phone check-in about breathing or postnatal wellbeing, letting them know that you’re there to help, not judge. Many patients are overwhelmed by relief when this happens, it is extremely rewarding.

The point isn’t the tool – it’s the signal:]we’re reaching out because you matter, and you’re welcome.

Flexibility also helps. Promote evening and weekend clinics – many people still don’t realise extended access exists. Offer phone or video consultations where appropriate. For some, that first step away from a face-to-face appointment feels safer, and it’s often enough to start an honest conversation.

Make bias awareness part of team culture

Every nurse can be an ambassador for an open, non-judgemental culture. Keep the topic alive in ordinary places: a two-minute reflection in the huddle, a quick share of a patient comment that made a difference, a poster that says clearly that everyone is welcome. Ask reception colleagues what they hear at the front desk and support them with inclusive messages to use.

The aim is to build a shared habit of noticing how people might be feeling before they say anything. Reception colleagues, healthcare assistants and admin staff all contribute to that atmosphere.

CHANGING THE NARRATIVE

We often see the impact of bias seeping into clinical settings - but it doesn’t start or end there. Bias is everywhere: in workplaces, on public transport, and in everyday family conversations. The Look Beyond the Bias campaign captures stories that many of us will recognise.

One that stayed with me was a woman living with asthma and COPD who was accused by strangers of being drunk when she was struggling to breathe and speak. Another was a rare liver disease patient and transplant recipient who was unfairly labelled an addict when his condition had nothing to do with alcohol or drug use. These are real people, and their experiences remind us of the quiet harm caused by assumptions and stereotypes.

EVERYONE IS WELCOME

Chiesi’s Look Beyond the Bias findings highlight how deeply stigma is embedded in everyday life – and how it can stand between people and the care they need.

As general practice nurses, we are in a position to make a different experience the norm. The steps are small but powerful: listen first, ask what matters, use open and non-judgemental language, reach out, make flexibility visible, and keep the conversation alive within the team.

When we do these things consistently, more people with asthma will feel that the disease is taken seriously and more people living with COPD, liver disease, rare diseases or mothers of premature babies will feel supported rather than blamed. That’s the culture I want in my practice – one where every patient feels they belong.

For more about the Look Beyond the Bias campaign, visit www.chiesi.uk.com/look-beyond-the-bias.

UK-CHI-2501015 | October 2025