The Echo Chamber Effect

How to avoid insularity and seek diverse perspectives.

echochamber ART

Imagine a small, enclosed space where a sound reverberates off the walls, repeating over and over again. This is an echo chamber — a literal space that’s filled with lots of sound, but what we hear is the same.

This term is also a figurative concept in which the same ideas bounce around, just like echoes, without being challenged or tested.

An echo chamber — whether at work or in one’s personal life — suggests an insularity and a lack of diversity in thinking. It often leads to poor decisions. When we only have one perspective, we don’t have the opportunity to explore other perspectives and options. It’s this exploration that enriches us and makes us confident in our decisions — whether they are as important as patient care or voting in an election or as simple as where to go on vacation. Echo chambers obscure the full spectrum of thoughts and, in doing so, leave us with blinders on.

Recognize the Signs

Echo chambers take many forms. You’ve likely experienced one if you are on social media. We think of social media as leveling the playing field, because we can connect with anyone. But who do you actually follow? It’s probably mostly people with your same sense of humor or the same belief system. When I visit Twitter or Facebook to think about a topic like health care reform, my followers may already agree with me, echoing my outrage or enthusiasm at the daily news.

"Do the decision makers have similar
beliefs because of their ethnicity,
race, gender, level of education, or
upbringing? If so, that’s a problem."

It’s possible that you’ve also experienced an echo chamber at your hospital or within your department. Do the decision makers have similar beliefs because of their ethnicity, race, gender, level of education, or upbringing? If so, that’s a problem — because the way they approach problems will be similar, but may not always be the best way.

I was at a meeting recently where we were trying to assemble patients with disabilities to measure their social needs. What is the process for accommodating a patient in a wheelchair who needs a mammogram? Does the machine go low enough? How far does the patient have to lean over? How much range of motion does the woman have to have? Does she need to support her entire body weight on her arms?

When the people discussing questions like these are homogeneous, it is frequently problematic. If we hire more diverse staff, we might have someone who is disabled orwho has a disabled loved one and can provide more acute insight into how to provide the best care possible for vulnerable populations.

Take Action

Challenging an echo chamber is not always easy. It takes a concerted effort and it can be uncomfortable. Sometimes it might even be confrontational, depending on why you’re in need of more opinions and perspectives. But it doesn’t diminish the importance of the act. Here are a few ways to get started:

Check your bias at the door. Understand what limited experience you bring to a situation — especially when it comes to where you tend to get your information. Think about seeking input from someone new. You don’t necessarily have to trust that advice right away, but just try to seek it out and consider why you haven’t approached them before. Is it because you bring an implicit bias? Is it because you just haven’t had the opportunity? Is it because you’ve been burned in the past?

Challenge others in small ways. When you see groupthink or groupspeak behaviors, come in from a position of knowledge and awareness to help advance the debate. You might even play devil’s advocate. Position the discussion as a thoughtful exercise to get the group to engage.

Speak up to leaders or allies. Some large practices or hospitals have channels where you can bring concerns up your chain of command. Mention anything suspicious, like a recurring problem that may signify that a particular group isn’t being heard — for example, female hires keep quitting, or few African-Americans apply to your practice. Encourage leaders to speak last in meetings, so the group doesn’t automatically agree with their initial statements.

Connect with allies. If your immediate supervisor is not receptive, there are ways to tactfully probe for other more supportive individuals. Organize an optional meeting of physicians, nurses, and other staff about echo chambers and diversity, creating a safe space to discuss if a problem exists. Get together to brainstorm ways that you might propose small culture changes to leadership.

Remember: disagreement is healthy. When tackling echo chambers, remember to expect some pushback and conflict. It’s not the idea you’re disagreeing about that’s toxic; it’s how you disagree about it. It’s important to seek an opposing opinion. When there is consistent unanimity over matters, no matter how large or trivial, then we risk sacrificing our goal: providing the best possible care.

 Ruth Carlos, MD, FACR, JACR Deputy Editor


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