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Biases Can Affect Patient Interaction

Despite the emphasis among health care professionals to practice evidence-based medicine, cognitive and implicit biases can affect how they make decisions and interact with patients. A Monday education session will examine how to deal with those biases.

“Thinking Differently About Thinking: Improving Your Decision-Making” willl be presented from 7:30 am-8:30 am Monday in Room 28DE.

“There is increasing interest in many fields, medicine being one of them, in how the brain works when it collects and processes information and makes decisions,” said Karthik Balakrishnan, MD, MPH, one of the session organizers. “There are some cognitive biases that can play into that.

“Cognitive bias is how the brain generally perceives, interprets, and applies information. Then there is the associated issue of implicit bias, which is how the brain perceives personal factors associated with the individual patient or other provider that affects how you interact with them.”

Several studies have been conducted in how cognition affects decision-making and medical errors, said Dr. Balakrishnan, assistant professor of pediatric otorhinolaryngology at the Mayo Clinic, Rochester, MN. The most studied specialty is emergency medicine. Because studies have not focused on other specialties, otolaryngologists have started to examine the effect of biases.

The session moderator, Ellis Arjmand, MD, PhD, has expertise in cognitive bias, and he will introduce its general concepts. He is the Bobby Alford Endowed Chair in Pediatric Otolaryngology and professor of otolaryngology and pediatrics at Baylor College of Medicine, Houston, TX.

“The key question is, ‘Why do things go wrong when you have a lot of smart, well-intentioned people working really hard for the patient?’ Dr. Balakrishnan said. “We will use that as a springboard to look at we how make our decisions and thinking about thinking. Dr. Arjmand will bring examples and do exercises with the audience to get them interested and bring out their own cognitive biases.”

Daniel L. Wohl, MD, North Florida Surgeons, Jacksonville, FL, and David Eibling, MD, University of Pittsburgh, PA, have been involved in quality improvement efforts. They will focus on how cognitive biases affect decision-making.

“They will talk about specific ways to reduce and prevent errors associated with those cognitive biases,” Dr. Balakrishnan said. “There are multiple specific biases, such as availability, anchoring, confirmation, and framing. They will discuss key biases and how they apply to our practices.”

Andrew J. Tompkins, MD, of the U.S. Navy, will examine how cognitive bias affects physician-patient interaction in making decisions about treatment.

“Dr. Tompkins will talk about informed consent and how to make sure patients are appropriately talked through the consent process for a medical procedure or treatment,” Dr. Balakrishnan said.

Dr. Balakrishnan will discuss the role of implicit bias.

“There are characteristics of individual patients that affect how we perceive them, and that affects our decision-making,” he said. “These include socioeconomic status, race, ethnicity, sex, age, weight, appearance, and sexuality that subconsciously affect how we decide to interact with, and treat, a patient.”

“Cognitive bias is present all the time and we are all vulnerable to it, and the same is true with implicit bias,” Dr. Balakrishnan said. “We are all potential victims of cognitive and implicit bias, and the best way to manage them and mitigate them is to be aware of them.”

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