Bias: a normal operating characteristic of the diagnosing brain

People diagnose themselves or receive advice about their illnesses from a variety of sources ranging from their family or friends, alternate medicine, or through conventional medicine. In all cases, the diagnosing mechanism is the human brain which normally operates under the influence of a variety of biases. Most, but not all biases, reside in intuitive decision making, and no individual or group is immune from them. Two biases in particular, bias blind spot and myside bias, have presented obstacles to accepting the impact of bias on medical decision making. Nevertheless, there is now a widespread appreciation of the important role of bias in the majority of medical disciplines. The dual process model of decision making now seems well accepted, although a polarization of opinions has arisen with some arguing the merits of intuitive approaches over analytical ones and vice versa. We should instead accept that it is not one mode or the other that enables well-calibrated thinking but the discriminating use of both. A pivotal role for analytical thinking lies in its ability to allow decision makers the means to detach from the intuitive mode to mitigate bias; it is the gatekeeper for the final diagnostic decision. Exploring and cultivating such debiasing initiatives should be seen as the next major research area in clinical decision making. Awareness of bias and strategies for debiasing are important aspects of the critical thinker's armamentarium. Promoting critical thinking in undergraduate, postgraduate and continuing medical education will lead to better calibrated diagnosticians.