Bias

Bias is a prejudice, attitude, or belief in favour or against a thing, a person, or a group, that prevents us from making an objective analysis or judgement. Biases are mental shortcuts that humans use to decide what is good or bad, what we like or do not like. All human beings have biases, but they can be changed once we know we have them and we can intentionally work to eradicate those that are harmful (UCSF, 2023).

Explicit Bias

Explicit bias refers to a person's conscious prejudices and beliefs about individuals or groups. For example, an active preference for a specific group and/or overt racism are rooted in explicit biases. People are more motivated to control their explicit biases when the social norms make clear that they are not acceptable.

Implicit Bias

Implicit biases are assumptions, attitudes, and beliefs of which we are unaware since they lie outside our consciousness. Implicit biases can go against our values, and they are a root of prejudice and discrimination since they impede a clear and accurate analysis or decision-making. This is why it is essential to identify them, to minimize the harmful effect they can have on our interactions.

Unconscious Bias

It is crucial to be aware of unconscious biases that we might have, since they can have an incredible impact on the people who are on the receiving end. Unconscious biases can create harmful environments where people are viewed negatively, which means, for example, students might experience poor group discussions or employees might miss a promotion. In addition, unconscious bias could affect our decision-making and hiring processes, ultimately contributing to more interpersonal, institutional, and systemic barriers. 


iHasco. (2018) "What is Unconscious Bias?" YouTube. Retrieved January 9, 2024. from https://youtu.be/Q5vhUPRygWk?si=l9S6nKv-RHGrOVyh

Institutional Bias

Institutional bias involves discriminatory practices that occur at the institutional level of analysis, operating on mechanisms that go beyond individual-level prejudice and discrimination. If not interrupted, Institutional bias perpetuates the disparities in advantages that some groups have over others. (Henry, P. J. 2010).

Cognitive Bias

Cognitive bias, stemming from the brain's tendency to simplify information processing through personal experiences and preferences, is a systematic thought process. This process, known as heuristics, helps prioritize and process vast amounts of information swiftly. However, while beneficial, cognitive biases can lead to irrational interpretations and judgments, often arising from memory, attention, and other mental errors. They operate unconsciously, making individuals susceptible to their influence without deliberate awareness. Amos Tversky and Daniel Kahneman introduced the concept of cognitive bias in 1972, and while completely eradicating these shortcuts may be challenging, recognizing their existence can aid in decision-making. (The Cleveland Clinic, 2023).

Examples of Cognitive Biases in Health Care

Confirmation bias

Confirmation bias involves selectively gathering and interpretation evidence to conform with one’s beliefs, as well as neglecting evidence that contradicts them. An example is refusing to consider alternative diagnoses once an initial diagnosis has been established, even though data, such as laboratory results, might contradict it (Smith, 2021).

Anchoring bias

Anchoring bias is much like confirmation bias and refers to the practice of prioritizing information and data that support one’s initial impressions of evidence, even when those impressions are incorrect. Imagine attributing a patient’s back pain to known osteoporosis without ruling out other potential causes. (Smith, 2021). This bias can occur in various contexts, from financial decisions to forming judgments about individuals based on stereotypes related to their race, accent, or background.

Affect heuristic

The affect heuristic describes when a physician’s actions are swayed by emotional reactions instead of rational deliberation about risks and benefits. It is context or patient-specific and can manifest when a physician experiences positive or negative feelings toward a patient based on prior experiences. (Smith, 2021).

Outcomes bias

Outcomes bias is a cognitive tendency wherein individuals tend to attribute clinical results, whether positive or negative, solely to prior decisions, even in the absence of valid reasons to do so. This bias can hinder the assimilation of feedback and impede performance improvement. It involves a preference for diagnostic decisions that are anticipated to yield positive outcomes, driven by a desire to avoid the emotional distress associated with unfavourable results. This bias can potentially lead to the underestimation of serious diagnoses due to the inclination to downplay negative possibilities in decision-making (Smith, 2021).

Tips for overcoming and preventing bias

Reflection is Key to Recognition

The first step in combating bias is acknowledging its presence. Acknowledge that everyone has biases, as denial can hinder openness to different perspectives. Everyone has biases that can impact decision-making and relationships. Encourage open dialogue and collaboration to combat bias in the workplace (The Cleveland Clinic, 2023).

Engage with Diverse Individuals

Seek out conversations and interactions with people from diverse backgrounds to gain a broader perspective on situations (The Cleveland Clinic, 2023).

Cultivate Cognitive Flexibility

Consider the context before making judgments or interpretations, as rigid thinking can overlook important nuances and gray areas (The Cleveland Clinic, 2023).

Challenge Your Decisions

Decision-makers should actively consider the opposite of their initial choices because reconsidering decisions can lead to more robust choices (The Cleveland Clinic, 2023).

Document Decision-Making Reasons

On an individual level, employees should document the reasons behind significant decisions. Regularly reviewing past mistakes and the rationale behind decisions provides valuable insights into improving decision-making skills (The Cleveland Clinic, 2023).

Sources:

University of California San Francisco (UCSF). (2023). Unconscious Bias Training. Retrieved from https://diversity.ucsf.edu/programs-resources/training/unconscious-bias-training

Vela, M. B., Erondu, A. I., Smith, N. A., Peek, M. E., Woodruff, J. N., & Chin, M. H. (2022). Eliminating Explicit and Implicit Biases in Health Care: Evidence and Research Needs. Annual Review of Public Health, 43, 477-501. doi:10.1146/annurev-publhealth-052620-103528 PMID: 35020445 Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9172268/

Henry, P. J. (2010). Institutional Bias. In J. F. Dovidio, M. Hewstone, P. Glick, & V. M. Esses (Eds.), The Sage Handbook of Prejudice, Stereotyping, and Discrimination (pp. 426–440). Retrieved from https://agep-nc.org/wp-content/uploads/2022/03/Henry-chapter-institutiona-bias-2010.pdf

Dovidio, J. F., Hewstone, M., Glick, P., & Esses, V. M. (2010). The SAGE Handbook of Prejudice, Stereotyping, and Discrimination. SAGE Publications Ltd. Retrieved from https://doi.org/10.4135/9781446200919

Smith, T. M. (2021, February 4). 4 widespread cognitive biases and how doctors can overcome them. Retrieved from https://www.ama-assn.org/delivering-care/ethics/4-widespread-cognitive-biases-and-how-doctors-can-overcome-them

The Cleveland Clinic. (2023, May 2). Cognitive Bias 101: What It Is and How To Overcome It. Retrieved from https://health.clevelandclinic.org/cognitive-bias/

AttendanceBot Blog. (2021, April 5). Ten Cognitive Bias Types in Workplaces. Retrieved from https://www.attendancebot.com/blog/types-of-bias/

The Decision Lab. (n.d.). Why do we rely on our current emotions when making quick decisions? Affect Heuristic, explained. Retrieved from https://thedecisionlab.com/biases/affect-heuristic

Croskerry, P. (n.d.). 50 Cognitive and Affective Biases in Medicine (alphabetically). Retrieved from https://sjrhem.ca/wp-content/uploads/2015/11/CriticaThinking-Listof50-biases.pdf