Commentary on Political Economy

Wednesday, 22 February 2023

I’m a Black physician, and I’m appalled by mandated implicit bias training

Opinion by Marilyn Singleton

February 23, 2023 at 3:04 Japan Time

Marilyn Singleton is a board-certified anesthesiologist and a visiting fellow at the medical advocacy organization Do No Harm.

I’ll never forget my parents’ reaction when I was accepted to the University of California at San Francisco’s medical school. Having attended segregated schools, my mother and father were thrilled that their daughter would attend a fully integrated, top-tier institution.

When I graduated with a medical degree in 1973, a Black woman in a class of mostly White men, there was a real sense that the days of obsessing over skin color and making race-based assumptions about our fellow human beings was finally fading — and, hopefully, soon gone for good.

Apparently not. That racial obsession has come rushing back — in academia, politics, business and even in my beloved medical profession. But now it’s coming from the opposite direction. The malignant false assumption that Black people are inherently inferior intellectually has been traded in for the malignant false assumption that White people are inherently racist.

That is the basic message conveyed by “implicit bias training,” which is now mandatory for California physicians; it is a message that I believe is harmful both to physicians and patients. There is a sad irony in all this, because the misguided focus on racism is intended to improve the health and well-being of Black patients in particular.

The law, which took effect last year, includes other bias targets, including gender identity, age and disability. But in practice, such training — a mainstay of the diversity and inclusion industry, worth an estimated $3.4 billion in 2020 — is overwhelmingly about race.

 In California, where I’ve been licensed since 1974, every physician is required by law to participate in this racially regressive practice. Doctors must take implicit bias training not just once but as part of the curriculum of “continuing medical education,” for at least 50 hours every two years, required for their medical license renewal.

The training’s focus is on exactly what the name suggests: Deeply ingrained prejudice toward people of different races. There is no room for debate, for the law states baldly: “Implicit bias, meaning the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, exists.”

And the law asserts as fact that implicit bias is responsible for “racial and ethnic disparities in health care,” particularly for Black women.

I am so disturbed by the state’s mandate that, so far, I have balked at the training. But I know that I must comply before the end of 2023 if I wish to have my medical license renewed.

Many of my friends and colleagues ask why I’m so upset by the law. Clearly, implicit bias training isn’t meant for me. It’s aimed at White people, who are far and away the biggest share of the medical profession. My answer is simple. I reject the unscientific accusation that people are defined by their race, not by their individual beliefs and choices. It is little consolation that studies are finding implicit bias training has no effect on its intended targets, and might even make matters worse.

Think about the message this mandate sends to Black physicians. It suggests that I should be wary of my White colleagues because, after all, they’re biased against people like me. Sure, they can undergo frequent training, but their bias is always going to be there, beneath the surface, threatening to rear its ugly, racist head. Collegiality and collaboration — two essential components of high-quality medical care — are targeted by this mandate. Call that an implicit bias.

Since I became a physician, I have seen exactly one instance of racism in health care — and it was from a patient, not a fellow physician. As for my colleagues, I have been consistently impressed with the conscientious, individualized care they have provided to patients of every race and culture. When we all took our oath to “first, do no harm,” we meant it, and we live it. I can’t imagine spending my entire career thinking my peers can’t uphold that oath without constant racial reeducation.

The message to physicians is bad enough, but the message to patients is much worse. Black people are, in effect, being told that White physicians are likely to quite literally damage our health. If that’s the case, why on earth would you seek medical care, unless you could be absolutely certain of not being treated by a White physician? And if you do seek medical care, why wouldn’t you doubt every word from a White doctor who is inherently prejudiced against you?

The whole point of implicit bias training is to create better health outcomes for Black patients and others who might be the target of discrimination, but the opposite seems more likely. It fosters a climate of distrust and resentment that threatens to undermine the medical and moral progress I’ve seen over the decades. When I graduated from medical school, we were moving past the era of racial obsession and anger. Why are we going back to the days when race defined so many lives and dimmed so many futures?

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