Bias – Does it influence your judgement?

Does this sound familiar?

It is 4am and the pager goes off. You see “75-year-old with a sore leg” or “65-year-old vomiting and diarrhoea” or an 18-year-old female “drunk”.

What would be your immediate reaction?

Be honest….

You probably, (myself included) have descended into the five stages of grief. Denial, anger, bargaining, depression, and hopefully, acceptance. Why? Because, whether we are aware of it or not, we believe that jobs like these aren’t what we should be going to. When university courses, TV shows, news articles and self-proclaimed “health advocates” on twitter focus so much on the high end of our work, why should we?

We believe our role, where we can practice our craft, is in the big work. We start to perceive our identity based on this belief.

When we associate this identity with an expectation and that isn’t met, we become discouraged, demotivated, and a little angry. And who do we blame? The person responsible for creating that feeling…the patient who called us.

So why could this be detrimental to our patient care?

An internal dialogue that starts with “We shouldn’t be going to this”, can easily lead to “I don’t think this patient requires an ambulance”. And because they don’t require an ambulance, my next thought might be, “this patient can’t be sick”.

This is the kicker. Based on little information, we have concluded that “this patient is not sick”

This is dangerous. This is bias.

Bias stops us from considering all the possibilities. Bias stops us from looking further once we have reached a decision. Bias makes us focus on the variables that affirm our belief that someone isn’t sick and ignore the variables that contradict it.

The sore leg can be septic cellulitis, the diarrhoea and vomiting can be acute adrenal crisis, and the drunk teenager can be having a stroke.

I’m no saint, and I will happily put my hand on my heart and say I am guilty of this. But being aware of your thoughts is the first step to correcting them. So next time you get a sore leg, or drunk at 4am, pause, acknowledge the bias, and try and approach the patient with an open mind.

Remember, to you it’s just another job. To the patient it may be the worst day of their lives.

To learn more about bias,

Check out Episode 5 – Deadly D and V

One thought on “Bias – Does it influence your judgement?”

  1. Guilty as charged…

    Good article, the only thing that I see differently is that the person who is responsible for creating our own feelings is always ourselves, and not the patient or anybody else. Feelings are the language of your body. Thoughts are the language of your mind. The mind-body connection happens when the body answers to your thoughts by expressing it with an emotion. And no one else can create these thoughts for you than yourself. That’s the difference between reaction (being at effect) and response (being at cause). By the way that’s where the word ‘responsibility’ actually comes from… being ‘response able’ by recognising that you have the ability to respond rather than just react to whatever life throws at you.

    As the picture at the top of the article about the 6 or 9 debate beautifully illustrates this, it always comes down to our perspective. Having worked in regions in this world myself where you would have to wait several hours for an ambulance to arrive or not being able to get any prehospital care at all has certainly given me this new perspective. Sure, cross my heart, nobody joins the paramedic profession for all these low acuity cases when they start (me included) and I too have a whinge about them at times (especially before having had a coffee or at 4am in the morning 😉). However having seen the opposite I have also realised that getting an ambulance in under 15mins for a possibly low priority complaint could also mean something else: that we’re actually living in a really well-off and highly privileged society… and for that I’m entirely grateful 🙏.

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