Understanding Bias in Surgery: Perceived Cultural Similarity Between Surgeons and Patient Families

Objective: We describe surgeon and parent perceptions of similarity toward each other and evaluate differences in the perceptions of similarity by race. Study Design: Observational cohort analysis. Setting: Three outpatient sites. Methods: Following consultations for children undergoing evaluation for 1 of 3 surgical procedures (tonsillectomy, hernia repair, circumcision), surgeons and parents rated their perception of cultural similarity toward each other on a 6-point Likert scale. Surgeon evaluation of 9 parent characteristics was measured with 7-point Likert scales. Regression analyses were performed to identify predictors of greater surgeon-perceived similarity and to assess associations of perceived similarity with evaluation of parent characteristics. Results: Most parents were women (n = 38, 84%), whereas surgeons were primarily men (n = 7, 54%). Of 45 parents, 23 (51%) were non-White, whereas only 4 of 13 clinicians (31%) were non-White. Mean perceived similarity score was 21.7 for parents (range, 10-24) and 18.2 for surgeons (range, 10-24). There was no difference in parent-perceived similarity based on race (White vs non-White parents, mean [SD] = 22.3 [3.4] vs 21.1 [3.0]; P =.26). Surgeons perceived greater similarity with White parents (odds ratio = 4.78; 95% CI, 1.02-22.54; P =.04) and parents with higher income (odds ratio = 11.84; 95% CI, 1.32-106.04; P =.03). Greater perceived similarity by the surgeons was associated with more positive assessments of parent personality characteristics. Conclusion: Surgeons perceived similarity more commonly with White parents, while parents’ perception of similarity to surgeons was uniform regardless of parent race. Elucidating biases of surgeons may help to tailor interventions promoting culturally competent, equitable communication and decision making for elective surgery.