This is my foray into the world of biases and how implicit bias affects decision-making in healthcare. As I was listening to a TED talk on bias, it made me wonder how often doctors are influenced subconsciously by biases and how it may affect diagnostic and treatment decisions.
As physicians, we are often taught to use algorithms, odds ratios, relative risks, likelihood ratios, and various statistical tools in decision-making. But these are only as good as the data available at the time of patient contact and the heuristic applied by the doctor at that 15-30 minute encounter.
What if a physician was to believe that a patient’s complaint about chest pain was musculoskeletal and confirms his thought process with a “reproducibility test”, but the patient in fact has a heart attack. This would be confirmation bias. Seeking information-in the case of doctors, ordering tests and treatments to confirm with their thought process. Statistically, the physician may be right as he is taught to think in this manner. However, the patient is dependent on the physician’s ability to take a good history, apply his knowledge, use his correct judgement, all the time hoping that the physician is up to date with the current guidelines
Many consultants dismiss the idea brought in by a patient or another referring physician. They believe that they know much more than others. However, this bias, “The Dunning Kruger ” effect may lead to a missed diagnosis. This is the effect where one overestimates their knowledge or underestimates their lack of knowledge. This also happens in a training institution where a senior professor may not be open to ideas of a junior resident or attending
Finally, when a physician is faced with data contrary to his belief and training he or she may ignore the newly gained information. This is “Cognitive Dissonance ” at play. New research is constantly being published which debunks old teachings. Before the information trickles down to a community physician, outdated treatments may still be provided.
We will explore more about these cognitive biases over the next posts. Suffice to say, an understanding that biases exist all around in our day-to-day lives, that they could be influenced by one’s upbringing, training, cultural background and they may make a difference in the life of a person is required.
Expanding our radius of medical knowledge, understanding the limits of our faculties, having an unbound curiosity to learn new data and be receptive to change would be of tantamount importance.