Leo Briggs, deputy head of the Dental Defence Union (DDU), discusses the importance of being aware of unconscious bias in dentistry.

figure 1

Unconscious bias is defined as an unfair belief about a group of people that you are not aware of and that affects your behaviour and decisions. As dental professionals, we make multiple decisions throughout the day. Many of these decisions have a significant impact on patients as well as our colleagues and other dental professionals.

These decisions are often based on our own personal experiences, training, and our background. The result of this is that we don't all come to the same conclusions but this can lead to decision-making bias.

figure 2

©ArtemisDiana/iStock/Getty Images Plus

This unconscious bias can also occur when making clinical decisions. Assumptions about a patient's understanding of symptoms, behaviour or risk for a particular disease or condition could mean the incorrect treatment is offered. Decisions influenced by unconscious bias about individuals, or a group of people could be discriminatory, unlawful as per the Equality Act 2010,1 and lead to inequity in care.

Confirmation bias, the process by which a person identifies selective evidence in support of a decision and ignores any evidence that conflicts with it, but without any conscious awareness of either step, can easily occur in a busy practice if assumptions are made. It can be partly managed by being consistent in taking a full history and considering this in line with recognised guidelines.

It is difficult to know for sure whether an incident has arisen from unconscious bias, but after a complaint or query it may be something to consider.

If you are seeing a patient for the first time from a background you are unfamiliar with, it is more likely for the brain to make implicit assumptions about them.

For example, did you assume that because of recreational drug use, a person engaged in other risk-taking behaviour? There can be an overlap with clinical experience of likely associations between these factors, but the only way to know that an association exists is to ask the individual patient.

Everybody is a product of their own experiences and the gaps in that experience often indicate potential biases. As a dental professional, if you are seeing a patient for the first time from a background you are unfamiliar with, it is more likely for the brain to make implicit assumptions about them. Recognising this in the moment can be challenging.

The first step should be recognising what biases you might have and to seek out training in recognising bias. The Implicit Association Test (IAT)2 is useful for highlighting unconscious bias. If you're aware of your blind spots, this creates the opportunity to reflect on your decisions and to ask yourself if you would make the same decision if the patient's demographics were different.