Overcoming the Implicit Bias Shortcut

Editor’s Note

In our daily lives, we strive to be fair and objective. Yet, beneath the surface, our perceptions can be shaped by hidden biases. Unconscious prejudices, or implicit bias, influence our thoughts and behaviors in ways we may not even realize. This editorial delves into the nature of implicit bias, exploring its origins, potential consequences, and the importance of recognizing its impact in our interactions with others.¹

Dr. Smiley has articulated what I have felt in my heart for many years. His editorial illustrates that our thought allies are many, varied, sometimes unexpected and always welcomed. He has humanized the dilemma of implicit bias and shown us clear direction for the future.

Kerry K. Carney, DDS, CDE

Editor-in-Chief

Journal of the California Dental Association

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Recently, I found an old press clipping in a box of my parents’ belongings stored in the basement of my building since my mother’s passing more than 18 years ago. The yellowed paper featured a photo of my mom, identified in the caption as Mrs. Harold U. Smiley, alongside other accomplished and educated women similarly identified by their husbands’ names. Despite their achievements, the journalistic style of the mid-1960s defined their identity and standing through their marital status. This practice wasn’t surprising; after all, it was at a time when many banks refused to let women open a checking account without a signature from their husbands or fathers. I returned the article to the box where I found it and hadn’t given it much thought since.

That was until I attended a lecture on implicit bias. Like California, Illinois, Maryland, and Washington state, Michigan requires healthcare providers to take implicit bias training to renew their licenses. Implicit biases involve associations outside our conscious awareness that lead to differential evaluation of a person, group, object, and more, usually based on irrelevant characteristics.²

In health care, research shows that implicit bias contributes to inaccurate diagnosis, the offering of different treatment options, differences in pain management, and poorer clinical outcomes for patients with different social characteristics.³

The lecturer, Dr. Marita Inglehart, of the University of Michigan School of Dentistry, noted, “We all have implicit biases. They are part of how human information processing is structured to create thinking shortcuts. The content, however, often creates unwanted consequences for us and others.” She then demonstrated that personal, educational, and environmental experiences impact the implicit bias we hold. This includes what we are exposed to through print, broadcast, and social media.

Immediately, my mind swung back to that old news clipping of my mother. Was the publishing style of that time reinforcing a harmful bias on the standing of women in society? As the editor of my state’s dental journal, what implicit biases was I reinforcing with my readers, and what were the consequences?

When I became an editor, Dr. Jessica Rickert, the first American Indian woman dentist, frequently wrote to me noting the ratio of diverse images and authors in the most recent issue of the Journal of the Michigan Dental Association. Dr. Rickert is actively involved in efforts to recruit members from native communities to pursue careers in oral healthcare, including establishing a dental scholarship at the University of Minnesota. Her mantra, “You can’t be it if you can’t see it,” underscored a need to intentionally publish diverse and inclusive material or risk the perpetuation of implicit bias in our readers. Mitigating content that supports implicit bias, be it age, race, sex, gender, sexual identity, skin tone, impairment, or weight, comes through editorial awareness and intentional action. For example, when selecting images for our cover or illustrating a feature article, we now ask if there are opportunities to introduce diversity with the photos we print.

As dental editors and journalists, we are responsible for translating the latest, best evidence into usable clinical guidance for our readers to implement and improve outcomes for their patients. Utilizing a blinded peer-review process circumvents the adverse impact prestige bias or recognition/familiarity bias can have on the content we deliver. Editorial awareness is a way to introduce rigor to detect and correct the harmful, unconscious, unintended mental shortcuts of implicit bias.

Projecting implicit bias that limits the expression of diversity may unknowingly damage a sense of belonging that will adversely impact the recruitment of colleagues into our organizations. If they don’t see it, they won’t be it. Likewise, implicit bias that unknowingly results in a colleague’s hesitancy to provide patient care, such as treating Medicaid patients, adversely impacts health outcomes.⁴ Personal, educational, and environmental experiences create and reinforce implicit bias.⁵

Our Journals serve as media messaging that can perpetuate or counter implicit bias. This educational experience can foster awareness and familiarity, motivating readers to detect and counteract its expression. Just as a clinician expresses awareness by questioning their consistency in treatment planning or providing pain management, as editors, we must ask if our content accurately represents the communities we serve and supports the outcomes our profession aims to achieve.

Implicit bias can evolve,⁶ but as dental editors and journalists, we can’t afford to wait. Captioning a photo of ADA President Dr. Linda Edgar as Mrs. Bryan Edgar is unacceptable. Through editorial awareness, we can combat the consequences of implicit biases by rejecting content that perpetuates harmful, inaccurate, and erroneous thinking, allowing our publications to age better than that yellowed newspaper clipping I found in my basement.

Additional information

Notes on contributors

Christopher J. Smiley

Christopher J. Smiley, DDS, CDE, serves as the president-elect of the American Association of Dental Editors and Journalists (AADEJ) and previously edited the Journal of the Michigan Dental Association. He received the 2020 ADA/AADR Evidence-Based Dentistry Practice Award and chaired the Dental Quality Alliance and the ADA Council on Dental Benefit Programs. Dr. Smiley has authored and spoken extensively on artificial intelligence in dentistry, patient-centered care, evidence-based care, quality improvement in health care and coding and dental benefit issues. He and his wife, Dr. Colette Smiley, reside in Grand Rapids, Michigan, where he retired from general dental practice in September 2023.