An exploratory study of blind spot bias in psychiatrists: The value of mindfulness and ethical skills'

Introduction: Psychiatry is an area of medicine that is particularly exposed to the risks of cognitive bias, notably because diagnosis is subjective. However, psychiatrists may develop psycho-cognitive skills that protect against bias, as the reflective approach to their patients favors the activation of system 2 (logical) as opposed to system 1 (intuitive) processes. Furthermore, the collegial practices found in psychiatry, a consequence of the ethical questions psychiatrists must address, can also mitigate the impact of bias. On the other hand, clinical ethics committees have adopted structured deliberation practices that aim to improve collective decision-making and limit the cognitive biases associated with groupthink.

Objective: The primary aim was to compare blind spot bias in a group of psychiatrists and a group of 'ethicists', experts in group deliberation. The secondary objective was to study the distribution of skills influencing the balance between systems 1 and 2 (notably, ethical deliberation, feeling of efficacy, mindfulness, and values) in both groups. The general hypothesis is that psychiatrists are less prone to blind spot bias and are more competent in the skills studied.

Methods: This descriptive, cross-sectional study was conducted from April 2022 to May 2023. Thirty-two psychiatrists were recruited from several French hospitals, along with 20 'ethicists'. All participants completed the following self-administered questionnaires: the Bias Blind Spot Scale (French version), the Euro Moral Case Deliberation (Euro-MCD, ethical skills), Bandura's self-efficacy scale (self and collective efficacy), the Freiburg Mindfulness Inventory (mindfulness), and the Schwartz Value Survey (values).

Results: The ratio of self/other blind spot bias was lower in the 'ethicists' group than the psychiatrists' group (P<0.001). Euro-MCD scores were higher (P<0.001) and psychiatrists tended to have a better sense of collective efficacy (P=0.08). No significant difference was found between the two groups for total mindfulness or presence and acceptance sub-scores. Scores for hedonic value were higher among psychiatrists (P<0.02).

Conclusion: The results do not confirm our hypotheses. There is less evidence of blind spot bias among our sample of 'ethicists', who are experts in group deliberation, than psychiatrists, who have experience of the patient/physician dyad. The ethical skills that are developed within the formal deliberation process seem particularly interesting in terms of reducing cognitive bias.