Implicit bias in healthcare: clinical practice, research and decision making

Abstract

Bias is the evaluation of something or someone that can be positive or negative, and implicit or unconscious bias is when the person is unaware of their evaluation. This is particularly relevant to policymaking during the coronavirus pandemic and racial inequality highlighted during the support for the Black Lives Matter movement. A literature review was performed to define bias, identify the impact of bias on clinical practice and research as well as clinical decision making (cognitive bias). Bias training could bridge the gap from the lack of awareness of bias to the ability to recognise bias in others and within ourselves. However, there are no effective debiasing strategies. Awareness of implicit bias must not deflect from wider socio-economic, political and structural barriers as well ignore explicit bias such as prejudice.

Keywords: cognitive bias; diagnostic error; implicit bias; unconscious bias.

Fig 1.

Decision-making processes. a) The interaction between type 1 and type 2 processes allows diagnoses to be made from patient presentations. T = ‘toggle function’; the ability to switch between type 1 and type 2 processes. b) The type 1 processes that control calibration of decision making to make a diagnosis. Adapted with permission from Croskerry P, Singhal G, Mamede S. Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ Qual Saf 2013;22(Suppl 2):ii58–64.