The word bias can be used differently in a variety of settings. In fashion, it’s essential to understanding designing and cutting fabric on the bias, or on the grain of the fabric (Business of Fashion, 2021). In math and statistics bias is an essential concept for accurate analysis. Just ask anyone who embraces research. When it comes to writing, the American Psychological Association (2019) has strict writing guidelines for bias-free language towards, age, disability, gender, racial and ethnic identity, sexual orientation, socioeconomic status, and intersectionality.

So what is bias in everyday life? Google and Oxford Languages define bias as, “prejudice in favor of or against one thing, person, or group compared with another, usually in a way considered to be unfair”. I often think of bias as judgements rooted in partial information. The partial information may have grown from family socialization, cultural values, fear, lack of exposure, group think, and other beliefs or experiences. It can be positive or negative.

Bias Example #1

A dinner conversation between a child and their aunt.

Child: “I don’t eat broccoli. I don’t like it.”

Aunt: “Have you ever eaten broccoli?”

Child: “No!”

Aunt: “How do you know you don’t like broccoli?”

Child: “Cause my parents don’t like broccoli!”

Bias Example #2

Daughter and mom out shopping.

Daughter: “Look! That’s Jay, the new boy at school. He’s so kind and smart. I really like him.”

Mother: That’s Jay? (A long pause follows.) The one with the body tattoos and long hair! Does he do street drugs? I bet he rides a motorcycle. Let’s go to the car!”

Bias Example #3

Healthcare student is in clinical with their healthcare preceptor.

Preceptor: “This patient has been a diabetic for over 10-years. This is the worst kind of diabetic patient because you can’t teach them anything. We see a lot of them from the southern part of the state. They’re just noncompliant!”

 

In example one, we may laugh and say this is the innocence of a child desiring to be like their parents. So cute! Yet, the child has developed a bias toward broccoli. It is harmful? Maybe, and maybe not.

The short description in example two, presents a mother who’s eager to leave once she sees what Jay looks like. From prior experiences the mother has linked body tattoos and long hair with street drugs and motorcycles. The mother is eager to leave the area with her daughter and does not acknowledge personal attributes the daughter shares about Jay, her new friend. The short example does not identify the mother’s associations, experiences, values, or memories that may ignite fear, concern and protectiveness for her child. Sadly, the mother’s associations are bias toward those with tattoos and long hair and potentially harmful on a variety of levels.

Healthcare providers are human. It requires disciplined practice to block personal biases, as well as prejudices and stereotypes, from entering the healthcare provider patient relationship. In the third example the preceptor verbalizes biases that may or may not be related. Let’s examine the preceptor’s statement more closely.

“This patient has been a diabetic for over 10-years. This is the worst kind of diabetic patient because you can’t teach them anything. We see a lot of them from the southern part of the state. They’re just noncompliant!”

The healthcare student might conclude, individuals who’ve been diabetic for more than 10-years are noncompliant and the worst type of diabetic patient to provide care. Additionally, the southern part of this hypothetical state, reside a large number of long-term diabetics who are noncompliant. By the way, what is noncompliant? According to Google and Oxford Languages, it is “failing to act in accordance with a wish or command”.

The preceptor student relationship is an unequal power relationship. The student is subordinate to the preceptor, and may view the preceptor as a leader, role-model, and an authority with the academic unit. Thus, giving the preceptor power.

Yet, the preceptor has role-molded and sanctioned the following biases. Individuals who have been diabetic for more than ten-years:

• are the worst kind of diabetic patient,
• you cannot teach them anything,
• the southern part of the hypothetical state has a lot of long-term diabetics, and
• this group of patients do not act in accordance with healthcare treatment; they are noncompliant.

Potentially, this healthcare student may internalize these biases and prejudge the next patient who has similar characteristics. The student’s future actions could be harmful, even life-threatening.

If the majority of healthcare providers have comparable biases regarding diabetics from the southern part of this hypothetical state, and they share their biases with healthcare students, the bias transmission may spread like a virus. If we have bias transmission, let’s consider the following questions.

• Will this group of individuals with the described characteristics receive adequate healthcare?
• Will the incidents of disease, injuries, and death be higher for this group of individuals than those who reside in other regions?
• What happens if additional biases are attached to this region?
• Overtime, what could happen to individuals with similar characteristics outside of this hypothetical southern region?

Is there danger in a bias against broccoli? Probably not. However, have you ever been around a group of four and five year-olds when one child declares they don’t like broccoli? Before you know it, the entire group declares they don’t like broccoli. If biases spread rapidly from person to person, like a virus, how do we stop the spread? What follows is one way to stop biases from spreading.

Ideally, self-identification or openness for others to identify when a bias exists is an initial step. Examination of the origin and intent of biases expose opportunities for awareness, learning, and understanding, to name a few. Action steps are generally indicated in order to stop the spread of negative harm from a bias. Regretfully, changing or stopping a bias is not easy. It requires motivation and continual practice. Recently I was on a zoom meeting. One of the members, we’ll call them Member A, used a common biased statement. Member B sent a private chat message stating the word may not have been the best choice to describe the situation and explained why. Before the end of the meeting Member A shared what happened, their new knowledge, thanked Member B, and apologized if they had offended anyone. Wow, I was so honored, proud, and excited that I know these colleagues. I have the joy of working and learning with them daily. They’re unsung heroes and role-models combating bias.