Introduction by Croakey: Over the past few years, the UK health system has been coming to terms with racism and other, often compounding sources of bias in healthcare.
In Australia too, we know that racism in healthcare is costing lives. In releasing a report from the Australian Human Rights Commission in 2025, Race Discrimination Commissioner Giridharan Sivaraman said:
“This report confirms what communities have been saying for decades: racism in the health system is not just unfair – it can kill. When people are denied care, misdiagnosed or treated with suspicion because of their race, the consequences are not theoretical. They can be fatal.”
Recent times have also seen the exposure of medical misogyny as a source of poor health outcomes for Australian women – a problem that is compounded for Indigenous women.
These biases are sometimes called “unconscious” or “invisible” but healthcare leaders have been told that they need to be explicitly recognised and dealt with, and that the tools to do so are at hand, reports Marie McInerney from the recent Royal Australasian College of Medical Administrators’ conference in Naarm Melbourne.
Anti-racism policy and training must be embedded across leadership, workforce, education, clinical care, research, and technology fields in healthcare, conference participants were told.
This is the final Croakey Conference News Service report from #RACMA2026, the College’s largest meeting to date, with 638 delegates attending the two-day conference (504 in person and 134 online), and 308 participating in the pre-conference workshops.
Do dip into our previous reports here, and don’t miss the announcement at the end of this post, of the winner of this year’s Margaret Tobin Challenge award.
Marie McInerney writes:
“Whose pain do we believe without qualification, and whose do we require to prove itself?”
The honest answer to this question, Tasneem Chopra OAM told a room full of health and medical leaders last week, is “a window into the culture we’ve built and into the culture that we must rebuild” in healthcare.
Chopra, a cross-cultural consultant and diversity, equity and inclusion trainer, spoke in a plenary session at the Royal Australasian College of Medical Administrators Annual Conference (#RACMA2026) about how the intersection of class, culture, and gender can create or change outcomes of health for minority communities.
Chopra highlighted what’s become known the “Mrs Begum syndrome” in the United Kingdom, described in one report as “the tendency to dismiss older Asian women as exaggerating their pain”.
“This is not a clinical diagnosis,” Chopra said. “It’s not in any medical literature.”
“It’s a shorthand for ‘she’s being dramatic, ‘she’s exaggerating’, ‘she’s attention seeking’.
“It’s a slur addressed as clinical observation and, once that label attaches, unrecorded, passed between colleagues in a corridor, it shapes everything that follows: the referral not made, the pain medication not prescribed, the mental health screening not initiated.”
As one research participant described it, it’s “institutional racism…we’re fobbed off as whining women.”
Learning to see bias
Chopra said the Mrs Begum syndrome names “with brutal precision” what she wanted conference participants to consider: that medical bias is not always seen.
“Sometimes it’s a word, a tone, a decision made beneath the threshold of conscious thought about whose pain is real and whose pain is imagined.”
Chopra described parts of her own life, being born in East Africa and growing up in country Victoria, with a pathologist father who worked with the Royal Flying Doctor Service.
She asked participants to imagine being a “South Asian-looking” doctor arriving in Australia one year after the White Australia Policy was lifted and assigned to treat Aboriginal and Torres Strait Islander patients in remote communities.
She later learnt he was warmly welcomed by the community “as a blackfella doctor”, and “understood something in that moment that no curriculum had taught him…that trust is the precondition for treatment”.
She referred the audience to a UK book published year: Anti-Racist Medicine: An Essential Guide to Advancing Equity in Medical Education, Research, Technology, Policy, and Practice, described as a first-of-its-kind textbook on how to deliver anti-racist healthcare for people in medical education, leadership, research, and practice.
Medical bias can’t be addressed without confronting racism “front on”, she said. Nor can medical professionals claim to be ‘race-blind’ or ‘colour-blind’ in medicine.
“Neutrality in a system already shaped by racial hierarchy is not neutrality,” she said. “It is complicity with systems that normally or unwittingly cause harm.”
Structural failures
Chopra also highlighted the End All Bias report, published by the Australian Multicultural Centre for Women’s Health last year and based on interviews with 140 migrant and refugee women.
She said it describes four structural failures that she was sure every administrator at the conference would recognise.
The first is that bias never operates in isolation. Gender bias, racism, ageism, and limited English capacity are “frequently intersecting and occur simultaneously”, she said.
“A young disabled African woman in a hijab does not experience ableism and then racism and then misogyny one at a time. She experiences them as a single compounded reality that no single access training framework is equipped to handle,” she said.
“This is intersectionality, presenting as a clinical reality in hospital waiting rooms today.”
Secondly, she said, discrimination operates at three levels simultaneously: institutional, systemic, and interpersonal. For example, digital health systems that exclude women without technological access, and reception staff functioning as informal diagnosticians, deciding before a clinical assessment whether a patient’s condition is serious enough to warrant an appointment.
“In these moments, the front desk is the first site of triage and can also be the first site of exclusion,” she said.
Thirdly, she warned, harm extends beyond the individual who experiences it because trust, once broken, “travels into families, communities, and informal networks”.
“When a person leaves a consultation feeling invisible, they tell everyone around them, and [that wider circle] stops coming.”
Fourthly, she said, when patients described what good care looks like, what they described was “not extraordinary”.
“They wanted to be believed, to have their language accommodated, they wanted to have access barriers anticipated rather than left for them to navigate and overcome alone.”
Tragic consequences
Chopra highlighted the tragic 2019 case of 27-year-old Wiradjuri woman Naomi Williams, who died of sepsis after presenting to hospital multiple times and being sent home with paracetamol — a “devastating example of what happens when the system cannot see the whole person”. (Croakey covered the multiple failures in care in this 2019 article).
She talked about other powerful case studies, including a woman, living in Australia on a temporary visa who was experiencing serious gynaecological conditions but was told her visa category excluded her from subsidised care.
“By the time she accessed treatment, her condition had significantly progressed, not because of failure of knowledge, but because of the policy mindset that decided her status of migration was more relevant than her diagnosis,” Chopra said.
“In every consultation along the way, clinicians processed a situation without escalating, without asking whether any other pathway existed. The human judgment of failure was distributed across every professional who absorbed a situation as someone else’s problem.”
Towards safe care for all
Chopra also offered a positive case study: a patient who attended a community health centre where a bicultural health educator was embedded in the service. She was greeted in language, given time to open up about her health issues, asked whether she needed practical support for transport.
The woman later described having felt happy and safe. She returned for follow up care, brought her daughter for an appointment, and spread the word in her community, all of which have wider impacts for healthcare, Chopra said: “mitigating long-term costs to the state” because of powerful short-term care interventions.
Chopra said research and modelling show that anti-racism policy and training must be embedded across leadership, workforce, education, clinical care, research, and technology fields in healthcare.
Medical training also must shift from a focus on equity and diversity requirements to understanding the structural determinants of health. Otherwise, she said, “we are training clinicians to acknowledge difference without equipping them to address the power structures that make the difference harmful”.
Chopra challenged conference participants to pursue systemic and personal change.
Within 12 months, she said, Australia’s healthcare systems could mandate accredited cultural safety training, including around ‘active bystander training’.
Within two years, intersectional health literacy could be embedded into medical education, with the Mrs Begum syndrome “taught as a live example of how clinical culture becomes a vector of harm”.
And within five years, she said, sustained advocacy from professional bodies like RACMA could ensure that equitable access is embedded structurally, rather than being dependent on the goodwill of individual practitioners.
At the individual level, she urged medical administrators to interrogate their assumptions, their practice of cultural humility, how they seek community input as co-design, how they address structural barriers, and to “recognise the benefit of stepping outside your comfort zone because from discomfort comes change, and from change comes growth”.
A win for handovers
#RACMA2026 also featured its annual Margaret Tobin challenge, with applicants from across Australia and Aotearoa New Zealand competing to deliver the highest calibre presentation in just 12 minutes aligned to the conference theme or sub themes.
Dr Phillippa Smith, the medical administration trainee at Nepean Hospital, in Sydney’s northwest, won for her presentation on ‘After hours medical handover – from blind spot to system fix’.
Smith’s project evaluated after-hours Junior Medical Officer (JMO) clinical handover practices, to identify risks to patient safety and continuity of care, and develop targeted recommendations to improve system performance.
A cross-sectional survey highlighted the need for change: only 30 percent of surveyed JMOs rated after-hours handovers as good or variable, and fewer than six in 10 rated critical information as reliably conveyed, she said.
Almost 40 percent reported their perception that incomplete handovers contribute to medical errors, “with a third saying this happens often”.
The survey found that key challenges to good handovers included competing clinical demands, including non-urgent paging, inconsistent communication regarding deteriorating patients, insufficient rostering overlap, and limited usability of electronic medical record tools.
Qualitative findings highlighted fragmented communication, unclear task allocation, and inefficiencies exacerbated by technological limitations, her work found.
“JMOs reported that they are trying to do a high-stakes communication task [while] undertrained, under time pressure, and with an information system and environment working against them”, she said.
While the survey was small and limited, she said, it was never intended to sit on a shelf.
Its findings and recommendations have been endorsed by the service, and “some wins have already been achieved: including improvements to the IT infrastructure in the room used for handover, tweaking our rosters to ensure adequate overlap, and improvements to the JMO handbook.”
Bookmark this link to follow Croakey Conference News Service’s coverage of #RACMA2026.
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