Unconscious Bias – in medicine and in life

When physicians in Maryland renew our medical licenses, we need at least 50 hours of continuing education.  Previously, in internal medicine, there were no specific topics to cover.  For our next renewal, are required to educate ourselves about unconscious bias as it affects our interactions with our patients, office staff and other medical professionals.  The webinar I watched, presented by Stanford University, struck me as having benefit to all of us, in our personal lives as well as in the workplace.

Any situation we encounter, we view through a lens shaped by our prior life experience.  This can create bias, and an error in decision-making.  We default to ‘efficient thinking’, basing new decisions on previous associations.  If we can recognize that we are doing this, we can try to disconnect inappropriate associations and biases based on ethnicity, religion, family, culture, gender, etc from our decision making process.

Linus Pauling updated ancient advice: “Do unto others 20% better than you would expect them to do unto you, to correct for subjective error.”

To stress the difference between what we may say and and where our unconscious bias leads, several studies were cited.  For example, all age groups explicitly showed positivity toward their own age group.  But in choosing, “who would be best for …”, everyone including older people preferred younger people.  Ageism is even present in older people.

The implications of unconscious racial or ethnic bias on hiring were studied as well.  In one study, equivalent resumes were sent with the name Greg Smith or Jamal Smith.  It was found that for  ‘Jamal’ to be competitive with ‘Greg’, he had to have 8 more years of work experience.  

The program went on to address the difference between diversity, which is having a mix of backgrounds, and inclusion, which is making the mix work.  More homogeneous groups may be more comfortable working together, but accuracy and creativity are greater with socially dissimilar groups.  

In medical practice, addressing issues that are ‘other’ for us can be difficult.  For instance this can include weight bias, descriptions of symptoms by someone of a different culture, unfamiliar gender or sexual identification.  As a result essential issues may not be explored adequately.

One parcel of advice was to become like a camera – i.e., take in the scene and avoid having your mind leap ahead.  An example was seeing two people walking into an exam room and assuming they were mother and daughter, rather than partners with disparate ages. Preferably, we would think, ‘There are two people’.  And then wait and ask questions to learn more. 

Are we stuck with our old ideas and biases?  What distinguishes those who have open minds and are creative thinkers?  In general, they have exposed themselves to different cultures, allowed themselves to truly listen to different perspectives, and remain open to reversing their own assumptions and opinions.  In a word, we should be aware that we ALL have unconscious biases, and aim to remain curious, explore, keep an open mind and be flexible about changing our opinions. 

What can we do to disrupt our unconscious bias? 

• Camera exercise.  Aim to use facts rather than interpretation in an unfamiliar situation
• Get to know others of diverse backgrounds better
•  Hold ourselves and others accountable.  If you hear someone say something that seems to be based on unfounded assumptions, you can politely ask, “What did she do to make you think that?”

• Establish clear evaluation criteria for hiring, raises, etc, to avoid different criteria for some.  Consideration of resumes without names attached.
• One team member can be the ‘diversity thinker’ or devil’s advocate.  Avoid situation of ‘group think’ by allowing every person at the table to offer a separate opinion, and consider doing silent votes instead of oral ones.
• If you’ve made an incorrect assumption, apologize, remember how and why it happened, and move on.   

As part of the webinar, we were encouraged to do a survey to assess our own implicit bias.  If this post has sparked your interest, you can try your hand at some of the evaluations regarding your views on age, gender, race, and other factors at  https://implicit.harvard.edu/implicit/takeatest.html.   I’d be curious about your thoughts. 

Sometimes just recognizing an issue, such as unconscious bias, is helpful in facing it head on.  And as Linus Pauling suggests, let that encourage us to give 20% more to compensate.