Practising dentistry requires quick decision-making on an almost constant basis. Some of those decisions have a significant impact on patients - and occasional implications for us as well.

Our decisions are based on experience, training and our background. We don't all have the same experiences and we don't all come to the same conclusions. This diversity should be celebrated, but it is also possible for some decisions to reflect gaps in our experience. We don't always know what we don't know, and it is these gaps that can introduce a bias to our decision-making without us realising.

What is unconscious bias?

Unconscious bias is a bias, assumption or prejudice against or in favour of a group that you are not consciously aware of. All decisions are potentially at risk of unconscious bias. Looking at the dento-legal implications of implicit biases, there is no reason to think that unconscious bias does not apply to relationships between colleagues, and it may also have an impact on complaints about dental professionals.

Impact on decision-making

Unconscious bias is also likely to apply to clinical decisions. Assumptions about a patient's understanding of symptoms, risk-taking behaviour or risk for a particular disease or condition could mean the correct diagnosis is missed. They can also affect the treatment offered - for example, if a patient's behaviour is challenging or contributed to their presentation.

It is good practice to consider demographics where the evidence base suggests doing so, as part of a conscious, considered process based on evidence and not prejudice. Decisions influenced by unconscious bias about a group of people could be discriminatory and lead to inequity in care.

That in itself is a reason to consider reducing unconscious bias - but if that discrimination is of a characteristic protected under the Equality Act 2010, then it is also unlawful, whether the dental professional is aware of the bias or not.

Types of bias

A number of types of bias have been proposed, such as confirmation bias. This is where 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.

In busy practice, this can easily happen 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.

Reviewing an incident

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

For example, did you assume the parents of a child knew more than they really did about dental health because they were well dressed? 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.

Taking action

We are all the product of our own experiences and the gaps in that experience often indicate our potential biases. 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. The Harvard Implicit Association Test is extensively used in research as a metric for unconscious bias. You can access this for free here.

Training in recognising biases

Another option is to seek out training in this area. 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.