Mindbugs In Medicine

There is a concept proposed in a book I recently read of the “mindbug,” which the authors define as “ingrained habits of thought that lead to errors in how we perceive, remember and make decisions” (Banaji, M; Greenwald, Anthony. Blindspot.  New York, Random House, 2013).   Through a series of tests that time the subject’s ability to associate different words to each other (Implicit Association Tests or IATs), they demonstrate the unconscious inferences that lie within the human brain, often illustrating a stark disparity between our ideals and our actions. When I read this book, I began to consider how these “mindbugs” might potentially influence the way I practice medicine, both in my interactions with my patients as well as with the residents I work with on a daily basis.

Even for the most open-minded physician, it is challenging not to form an opinion about a patient prior to entering the exam room.  These inferences may begin with simply seeing a name on a chart, reading the chief complaint or the brief description provided by the resident or MA working with you in clinic.  The “mindbug” theory implies that beyond the associations I consciously think about prior to entering the room, I also likely have a series of unconscious inferences that may subtly guide my thought processes.  For example, despite being a female surgeon in an orthopaedic department with 10 female attendings, I still fall prey to a riddle within Blindspot that you can’t solve if your mind assumes surgeon = male.

We each have pre-conditioned notions about patients of different professions, ethnic groups, genders, age groups, etc.  In saying this, I am not implying that we are all racist, ageist and sexist.  However, based on our previous experiences and societal exposures, it is almost impossible not to have these underlying thoughts.  Different social histories or cultural cues may influence the questions you ask, or don’t ask, in the exam room.  An unconscious inference may prevent you from asking an unconventional question.  The “bias” may be as simple as reflexively treating a fellow physician differently than you treat other patients or may be more complex and/or subtler.

So, how do we improve our ability to see the whole patient and to treat them without any underlying “mindbugs?”  The authors of Blindspot suggest that “blinding yourself” is the best way to avoid unconsciously acting upon an implicit association, but clearly we can’t treat our patients without seeing them.  Another suggestion is to flood your brain with less “conventional” associations so that your mind can perhaps begin to change your previous unconscious inferences.  Although the authors admit there is no foolproof way to eliminate these hidden biases, I think it’s important to acknowledge that these disparities exist within each of us.  Once we recognize their potential existence or identify the specific “mindbugs” that may exist in ourselves, it may be possible to begin eliminating them.

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Dr. Fishman is a hand and upper extremity surgeon at Loyola and the Shriners hospital in Chicago, Illinois. Her academic interests include pediatric/congenital upper extremity, brachial plexus and tetraplegia. Away from the hospital, she enjoys running, avidly following Duke basketball and all Boston sports teams.

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