Mental Shortcuts Become Risky Biases

Doctor holding red stethoscope

Unconscious bias is everywhere- but there are few places where it is more dangerous than in health care.

In The New England Journal of Medicine, Ruth L. Newhouse Associate Professor of Health Care Policy Anupam B. Jena, MD, PhD, and colleagues investigate the effects of left-digit bias, the tendency to categorize numbers by their left-most numeric digit, on coronary artery bypass surgery.

After a heart attack, patients who had just celebrated their 80th birthdays were less likely to receive coronary artery bypass surgery as compared to those patients who were just about to turn 80. Although the patients were relatively the same age, doctors perceived the group that had already turned 80 to be much older.

“The doctors might have perceived them to be ‘in their 80s’ rather than ‘in their 70s,’ ” Jena said in The New York Times. “This behavior seems to have translated into meaningful differences for patients. The slightly younger patients, more likely to undergo surgery, were less likely to die within 30 days.”

Coronary bypass surgery isn’t the only place left-digit bias is present in health care, it is common throughout clinical decision making. Patients with hemoglobin levels of 9.9 grams per deciliter may be considered more anemic than patients with hemoglobin levels of 10.0 grams per deciliter- even though the difference in values has no clinical significance.

Efforts have been made to reduce biases in clinical situations, with digital programming created to nudge doctors towards making the right decisions. However, when mistakes come with such high risk, the responsibility of avoiding bias ultimately falls on the physicians.

This article has been featured in the American Journal of Managed Care, Kaiser Health News, NewsDio, Chicago Tribune, Advisory Board, and covered by Reuters in The New York Times,.