What If We’re All Thinking Wrong? Cognitive Biases in Medicine, Part II
A Philosophical Reflection
I. The Patient is Not Exempt
There is a common misconception that the medical consultation is a one-way distortion, a rational doctor meets a confused patient and gently nudges them back into the realm of logic. But the distortion, like most things human, is mutual.
1. The Halo Effect in the Exam Room
A good-looking doctor is often perceived as more competent, more trustworthy, more intelligent. Patients unconsciously assume that someone who speaks well, dresses well, and exudes confidence must also know well. It works in reverse too. A disheveled junior doctor, new to the hospital, is more likely to be questioned, ignored, or assumed to be less capable, no matter how sharp their mind.
This bias infects medical hiring, evaluations, and even which patients receive more detailed explanations.
2. The False Consensus Effect
Patients often assume that everyone shares their health values. A patient who exercises daily may underestimate how hard it is for others to change habits. A traditional elder may believe "everyone knows herbal remedies work better than pills," while a young professional might assume "everyone knows vaccines are essential."
When these assumptions clash with medical advice, trust collapses. The clinician must learn to name the bias without shaming the worldview.
II. Bias in the Architecture
We must remember that cognitive biases do not arise merely within minds. They also exist within systems, the structural and cultural templates we inherit.
3. Availability Heuristic in Public Health
Diseases with high visibility receive disproportionate funding. Cancer receives more global attention than mental illness. Pandemics steal the spotlight from endemic killers like tuberculosis.
Health ministries, NGOs, and donors often make decisions based on recent headlines rather than longitudinal data. The bias becomes policy.
4. Conservatism Bias in Medical Education
New doctors are trained on decades-old dogmas. As such, clinical practice can lag behind evidence. Students learn to mimic outdated norms under the illusion that medicine is static.
Old truths survive long past their expiry date because the system is allergic to change. Even when the evidence changes, the teaching lingers. It takes extraordinary effort to update the architecture.
III. And Yet, We Heal
The presence of bias is not a tragedy. It is a biological inevitability. Our brains are prediction machines, optimized for speed, not accuracy. Biases are simply the echoes of evolution attempting to survive.
5. What Do We Do, Then?
We cannot de-bias ourselves into perfection. But we can:
Slow down at key decision points
Seek second opinions
Use checklists and protocols to counteract error
Train ourselves in cognitive flexibility
Practice intellectual humility
Most importantly, we must create spaces for doubt in clinics, classrooms, and conferences. The clinician who admits uncertainty is not a weaker clinician, but a wiser one.
6. Towards Metacognition
Ultimately, what we need is not just more intelligence, but better awareness of our thinking. Metacognition, thinking about how we think, is medicine’s next frontier.
Imagine if every health worker were trained not just in anatomy, but in attention. Not just in treatment protocols, but in introspection. What errors might we prevent if we learned to pause and ask: Am I thinking clearly? Or just comfortably?
End Note: The Patient as Partner
In a truly modern health system, the patient and the doctor would co-examine not only the body, but the beliefs that shape their choices.
Both would ask, not just What is the diagnosis?, but What stories are we telling?
And if we ask it well enough, often enough, we might not only heal.
We might think better.
If this resonated, share it with someone who lives on the edge of medicine and meaning. And if you noticed a bias I missed, write back. I am always willing to be corrected.
To heal is to understand.
Dr. Prince Wushe