Bias in dentistry and how it shapes the way dental professionals care for patients

Defining bias in the dental context

Bias may be defined as a predisposition or prejudice, whether conscious or unconscious, that influences judgement, decision-making and behaviour. Of particular relevance in clinical settings is implicit bias, which refers to attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious manner. These biases may influence our actions in ways that contradict our consciously held beliefs and values. In contrast, explicit bias involves attitudes and beliefs that are consciously endorsed and can be deliberately controlled.

Distinguishing between the effects of implicit bias and diversity is essential to understanding their distinct roles in shaping workplace culture and patient care. Diversity pertains to the representation and inclusion of individuals from varied backgrounds, identities and perspectives within an organisation. Implicit bias, on the other hand, relates to the unconscious assumptions and stereotypes that may persist regardless of the diversity present. The existence of a diverse workforce does not, in itself, eliminate the effects of implicit bias, nor does mere acknowledgement of bias equate to substantive progress towards equity.

Manifestations of implicit bias in dental practice

To address implicit bias effectively, dental professionals must recognise its various forms and the ways in which it may manifest in clinical practice. Common types of implicit bias include:

• Confirmation bias: The tendency to seek or interpret information in a way that confirms pre-existing beliefs. For example, assuming that a patient who reports recreational drug use is likely to engage in other high-risk behaviours without further enquiry may lead to inadequate care.
• Affinity bias: The preference for individuals who share similarities with oneself, such as background, appearance or cultural identity. This can result in disparities in the time, attention or empathy extended to certain patients.
• Attribution bias: The inclination to attribute a person’s actions to intrinsic character traits rather than considering external circumstances. For instance, interpreting a missed appointment as irresponsibility rather than recognising potential logistical barriers.

These biases are particularly likely to influence patient care when information is incomplete and assumptions fill the gaps. Factors such as a patient’s attire, socioeconomic status or insurance coverage may unconsciously shape the scope of treatment options discussed. Research suggests that even seasoned clinicians may unconsciously rely on stereotypes during initial patient interactions, especially in situations characterised by uncertainty or time constraints. This reliance can significantly shape their initial impressions and subsequent decision-making regarding patient care.

The cognitive basis of bias

The persistence of implicit bias can be understood through the lens of cognitive psychology. Dr Daniel Kahneman’s dual-process theory distinguishes between System 1 (fast, automatic, unconscious) and System 2 (slow, deliberate, conscious) thinking. Implicit biases reside within System 1, which governs the majority of cognitive activity, while System 2 is responsible for reflective and analytical thought. Recognising the predominance of System 1 thinking underscores the importance of intentional strategies to mitigate bias in clinical decision-making.