Part 2 - Individual Bias vs Institutionalized “-isms”
We all have bias. Let’s normalize that we are all flawed human beings and that is OK!
We too are working on being our best selves and are on a journey to better understand our bias. This blog is not a platform for us to pontificate and condemn. It is a space for us to create a shared knowledge foundation from which we can come together to creatively solve institutionalized “-isms.” It is helpful to work from a place where we understand the definitions of terms we are using and the history of their use.
Heuristics are built on emotional experiences and patterns, not logical reasoning:
Historically bias was a synonym of preference. In psychology and anthropology bias is defined as an inherited preference or learned preference. For example, an inherited dislike of bitter foods. In this way, bias is seen as a conserved evolutionary trait because of how it connoted a survival benefit. Avoiding toxic foods on knowledge alone is dangerous for humans. We have taste to reinforce eating for survival and avoiding foods that will make us sick or kill us. Although our taste buds are quite remarkable, they are not infallible. As such, inherited preference against bitter foods conveyed a survival benefit since many bitter foods are poisonous. Over time, people have un-learned this bitter bias by exposing themselves to harmless bitter foods with positive reinforcers. For example, learning to like coffee or many vegetables (like watercress) [1]. Check out the Decision Lab to learn more about cognitive bias.
Bias (such as bitter food aversion) decreased our cognitive load similar to heuristics. Heuristics are mental shortcuts that we learn through patterned/reinforced thoughts/behaviors. For example: we do not have to think how to tie our shoes, we have patterned that behavior so that we can tie our shoes and talk at the same time. Heuristics, like bias, can be helpful and harmful. When we offload some of our cognitive processes, we can spend our mental energy on more complex tasks or complete two tasks in parallel (aka what we call multi-tasking). Check out this article on the history of understanding Heuristics by Nature.
No matter how benign a bias or heuristic is on it’s surface, it can become problematic when we rely on it too heavily. When we are using a bias or heuristic, we are by definition not thinking critically. When we reinforce defaulting to bias/heuristics, we “check-out” and are no longer assessing the value and appropriateness of these short-cuts.
We are not trying to create a world where we incessantly question every single thought or behavior. Instead, we are trying to highlight that these biases were developed as the most conservative (most cautious) approach to survival. From this knowledge we can be more conscientious about how we use heuristics/bias. By identifying where we are defaulting into cognitive shortcuts, we can decide which are not in-line with our values and where we have the time/energy to unpack them and create new behavior change.
The above understanding of bias or heuristic is helpful for individualized change. Individual growth is critically important for our own health and happiness. We will talk about strategies for coping with institutionalized “-isms” and behavior change to align our actions and our values in future posts.
However, it is ill advised to shift the blame of the oppression and harm from “-isms” to the individual trying to survive. Placing the burden of change solely on the shoulders of the individual changing is not the solution. Individual change is apart of growth as a society. And there are numerous individuals who have created monumentous institutionalized change. Our goal however, is to hold institutions accountable and create a roadmap for institutional change.
As society has become more aware of institutionalized bias as the foundation to oppression there has been a push to create more linguistic clarity around the definition of bias. When we refer to institutionalized bias, we are referring to a term defined as “a tendency to believe that some people, ideas, etc., are better than others that usually results in treating some people unfairly” [Britannica Dictionary]. By this definition institutionalized bias and “-isms” are the same.
Because many of our “-isms'' are built on arbitrary concepts, such as race, which is not a biological definition but a social construct [2], we are facilitating hierarchical prejudice founded on unscientific biases. Intersectionality of institutionalized “-isms'' is why we fail to have health equity despite decades of steps [3] intended to improve healthcare outcomes for all [4].
Institutionalized “-isms” are systemic and affect everyone within the institution. Our institutions are housed within larger institutions. For example, our hospital is an institution housed within the institution of the county, state, and federal healthcare systems. Everyone, patients and physicians alike, are affected by these “-isms” and these “-isms” intersect and exponentially directly and indirectly affect outcomes. There is much to unpack and address within the context of remediating institutionalized “-isms”, which is why we have created this series on how to identify and remediate institutionalized “-isms.”
Similar to the approach we would take with ourselves, recognizing “-isms” entrenched in our institutions is the first step towards remediation.
Author: Shay Strauss, MD is a current second-year emergency medicine resident at Brown Emergency Medicine Residency.
Faculty Reviewer: Taneisha Wilson, MD is an attending physician and educator at Brown Emergency Medicine.