Bernard Luis Lopez, MD, MS, CPE, associate provost for diversity and inclusion at Thomas Jefferson University Hospital spoke at the Department of Emergency Medicine Grand Rounds on the topic of “Unconscious Bias – What You Don’t Realize That Affects Every Life Action,” Oct. 10.
As associate provost, Lopez is responsible for the formulation of a strategic vision and implementation of initiatives and activities to advance the diversity and inclusion efforts of the individual colleges that make up Thomas Jefferson University in Philadelphia as well as the university as a whole in its research, education, clinical, and service missions.
“When looking at your Grand Rounds schedule, this is probably not your typical topic,” Lopez said. “It’s usually what’s the latest and greatest in sepsis or trauma. But you’ll see that this is perhaps as, if not more, important a topic than some of the things you may normally see in a Grand Rounds for emergency medicine.”
Lopez opened his lecture with a simple definition of the word bias, which reads “a tendency or an inclination that results in judgment without question.” He stated that while people often think of bias with a negative connotation, this is actually a neutral definition that can show bias in a positive light as well.
“Bias really serves to protect us. This is something that is built into us as human beings,” Lopez said. “We all have these biases, and a good part of them exist to protect us from harm.”
Bias occurs because humans are constantly taking in bits of information, approximately 40 million bits at any one time, and they cannot consciously process each at the same time. Lopez said you may only be aware of 40 to 50 of those bits, and you may only be able to process five at any given time. The bits of information enter your brain and form schemas, or non-conscious hypotheses, that influence judgements of others.
The more information the brain takes in, the more the brain learns which gives someone a background for how they view the world in which they live. Each person, though they may have similarities with someone else, views the world from a different lens because of the different backgrounds from which they have learned.
Lopez detailed the neurobiological reason that bias works, beginning in the brain. A person sees something, and what they see comes through the lens in which that person views the world. That image goes into the fast, or emotional brain, which gives them an immediate reaction, usually with slight emotion.
“We typically make our assumptions very quickly,” Lopez said. “We see something, and we react very quickly, and it’s based on our lenses, our experiences, and our beliefs. Then when we see something that’s different, we start to use our slow brain. Something that we might use to try to figure out ‘why does this not fit?’”
Lopez gave examples of everyday situations where bias has been researched. He spoke of car salespersons who present sales pitches different based on who they are selling to or that in situations where hurricanes are named after females, higher death rates occur than in storms named after males because of the connotations of their names. Lopez also noted that physicians take biases into health care and hold biases against patients, and patients also have biases against physicians, which can make complicated medical situations even tougher to deal with.
“The good news is, we can shape our unconsciousness and our minds,” Lopez said. “You have to be aware of it. You have to make a conscious effort to change your unconsciousness. It sounds really complicated, but in reality unless you do that, you’re going to accept it as fate, and you really shouldn’t be doing that.”
Lopez said the first step to changing your unconsciousness is recognizing that you have bias, because it is part of who you are as a human. From there, people have to become intrigued by their biases and learn where they came from before they can engage with other people to change their background and the lens with which they view the world.
“We all have our biases,” Lopez said. “Not only is that okay, but it’s essential to our survival. It’s part of who we are as human beings. We can’t help that we have them, but you can’t use that as an excuse. In reality, we’re all connected together, so that’s why it’s so important. It’s for us, and it’s the patients that we serve and care for.”
Lopez wrapped the lecture by having the audience take a test on bias from Project Implicit. Project Implicit is a non-profit organization and international collaboration between researchers who are interested in implicit social cognition – thoughts and feelings outside of conscious awareness and control. To take any of the Project Implicit tests, click here.