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Otolaryngol Clin North Am. 2019 Feb;52(1):35-46. doi: 10.1016/j.otc.2018.08.016. Epub 2018 Sep 20.

The Impact of Cognitive and Implicit Bias on Patient Safety and Quality.

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Department of Otolaryngology and Mayo Clinic Children's Center, Mayo Clinic College of Medicine & Science, 200 First Street Southwest, Rochester, MN 55905, USA. Electronic address:
Bobby Alford Department of Otolaryngology-Head and Neck Surgery, Texas Children's Hospital, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA.


Humans use cognitive shortcuts, or heuristics, to quickly assess and respond to situations and data. When applied inappropriately, heuristics have the potential to redirect analysis of available information in consistent ways, creating systematic biases resulting in decision errors. Heuristics have greater effect in high-pressure, high-stakes decisions, particularly when dealing with incomplete information, in other words, daily medical and surgical practice. This article discusses 2 major categories: cognitive biases, which affect how we perceive and interpret clinical data; and implicit biases, which affect how we perceive and respond to other individuals, and also discusses approaches to recognize and alleviate bias effects.


Cognitive bias; Heuristic; Implicit bias; Metacognition; System 1; System 2

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