During my early years as a clinician, when I practised in a subacute facility in the Bronx. I remember being asked to consult with a patient who had a low-grade fever for three days. As I walked into this patient’s room I could tell the disappointment on her face as she muttered under her breath “Oh-no, not another young one”. I began to wonder how often we miss opportunities simply because they do not support our views and opinions? This kind of disposition is generally understood as cognitive bias.
The concept of cognitive bias was introduced by Amos Tversky and Daniel Kahneman in 1972. It was developed out of their insight into people’s innumeracy, or inability to reason intuitively with the greater orders of magnitude. They identified various ways in which human judgments and decisions differ from rational choice theory. Having explained the human differences in judgment and decision-making in the term of heuristics- a mental shortcut that provides quick judgments about the possibility of uncertain occurrences. Heuristics are easy for the brain to calculate but occasionally initiate “severe and systematic errors.”
This simply means that –Cognitive bias is a systematic error in thinking that arises when people are analyzing and interpreting information around them that impacts the decisions and judgments that they make. The human brain, though capable of many things, is constrained. Cognitive biases result from your brain’s attempt to simplify the interpretation of information with relative speed to help make sense of your environment.
The question of bias is one that is riddled with confusion and uncertainty that you cannot differentiate between sound decisions and cognitively biased decisions. This question of bias can sometimes be counterproductive especially in the healthcare system.
Having interfaced with patients for over thirty years, I have come to realize that some patients equate the clinician’s clinical knowledge base with either the clinician’s physical appearance, age/gender, and what they probably have heard or perceived about some clinicians, not based on the clinician’s capabilities. Though these biases are mostly unconscious-they can be problematic in healthcare, and can present as attitudes, mindsets, or other complex behaviors. Some of these mindsets may prevent the patient from adhering to the measures provided to improve her health.
Cognitive bias is an intrinsic part of human nature. Making rational and logical decisions devoid of bias can be difficult since our emotions and subconscious programming-the basis for our biases -run ninety-five per cent of our waking life activities.
The first step to communicating rationally and effectively is to come to the point of self-awareness that allows us to accept the fact of our cognitively biased human nature.
The second step is to use what the learning coach Ugo Chukwu in his book An Exercise in Clear Thinking calls “Intelligent Questioning” to self-assess your thought process by asking yourself certain questions that address the reason behind your decision and how you arrived at them.
At the heart of most anxieties that patients present when they meet with a clinician is a cognitive bias. As a psychological disposition, it is the main source of communication breakdown. If you’re going to build a healthy clinician-patient relationship, it begins with understanding the markers of cognitive bias when they rear their heads. This is important for you as a patient or as a clinician because on both ends the slightest misunderstanding can lead to a breakdown of trust – a key component of sustaining healthy communication.
As Abhijit Naskar, writes in his book Autobiography of God: Biopsy of A Cognitive Reality, “Each of your brains creates its own myth about the universe.” If you understand that the majority of your beliefs and opinions about people and the world are all conjured up myths we use in interpreting the world then you would learn to apply them with caution, humility, and empathy when interfacing with others especially in healthcare settings, for that is where communication and life begins.
