We all know that data show implicit bias training doesn’t work, and could even be counterproductive by making blacks and whites more suspicious of each other. And yet there’s been no move to ditch implicit bias training; in fact, it seems to be spreading. As physician Marilyn SIngleton, a black doctor in California, reports, it’s required in California as part of “continuing education” for doctors—50 hours of implicit bias training—mostly involving race, but also gender, age, and disability—every two years. That’s a lot of hours for a method that doesn’t work! Its continuance and spread serve only to show that the organizations that mandate the training are doing something. But because the training is useless, this is purely a show of virtue.
You can read Singleton’s Washington Post op-ed by clicking on the screenshot below, and I found it archived here for free. I recommend reading the whole thing because it’s very good. (And it’s in the WaPo!)
Singleton is identified this way:
Marilyn Singleton is a board-certified anesthesiologist and a visiting fellow at the medical advocacy organization Do No Harm.
She’s also pretty courageous, because I can imagine the social-media opprobrium, not to mention ostracism among her fellow doctors, for speaking the truth:
A few quotes, but really, I’d like to quote the whole thing:
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.
. . . 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.
JAC note added later: It’s not clear exactly how many hours of the continuing education is devoted to implicit bias training, as one reader points out below. However, more than one hour is too much. I’ve been to a class on implicit bias at the U of C, and have also taken implicit bias tests (I was diagnosed as “not biased,” but I can see how easy it would be to game those tests.) I found the class patronizing and almost insulting when they asked us to tell stories about how we may have manifested implicit bias.
Here’s part of what that law says: flat assertions with no evidence to back them up (bolding is mine)
Section 1.
The Legislature finds and declares all of the following:
- Implicit bias, meaning the attitudes or internalized stereotypes that affect our perceptions, actions, and decisions in an unconscious manner, exists, and often contributes to unequal treatment of people based on race, ethnicity, gender identity, sexual orientation, age, disability, and other characteristics.
- Implicit bias contributes to health disparities by affecting the behavior of physicians and surgeons, nurses, physician assistants, and other healing arts licensees.
- Evidence of racial and ethnic disparities in health care is remarkably consistent across a range of illnesses and health care services. Racial and ethnic disparities remain even after adjusting for socioeconomic differences, insurance status, and other factors influencing access to health care.
- African American women are three to four times more likely than white women to die from pregnancy-related causes nationwide. African American patients often are prescribed less pain medication than white patients who present the same complaints, and African American patients with signs of heart problems are not referred for advanced cardiovascular procedures as often as white patients with the same symptoms.
- Implicit gender bias also impacts treatment decisions and outcomes. Women are less likely to survive a heart attack when they are treated by a male physician and surgeon. LGBTQ and gender-nonconforming patients are less likely to seek timely medical care because they experience disrespect and discrimination from health care staff, with one out of five transgender patients nationwide reporting that they were outright denied medical care due to bias.
More from Dr. Singleton:
. . . 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.
Now of course you can dismiss Singleton’s claims because they are her “lived experience”, but you could just as well dismiss the claims of all the medical schools and the proclamations by medical associations that the whole profession is rife with systemic racism. In fact, at least Singleton has some evidence or her claims, but med schools and medical associations have only the “evidence” that there are disproportionately few black doctors compared to their proportion in the general population. But as we know, inequity is not prima facie evidence for racism—systemic or otherwise.
Singleton notes that black patients get an even worse message, which is that white doctors could hurt their health. And that message is injurious to the health of black people.
She finishes her piece this way:
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?
If you want to see evidence compiled by Lee Jussim that the concept of implicit bias is flawed and that training to eliminate it is useless, go here or see the video here.
Here are the three steps that are skipped when organizations mandate implicit bias training:
a.) Ascertaining that inequities are the result of racism
b.) Assuming that the racism is expressed unconsciously, via “implicit bias”
c.) Assuming that implicit bias training actually works in eliminating racist attitudes
All three assumptions have no evidence behind them, ergo implicit bias training is unscientific. As ever, I’m not denying that some white people in the medical establishment are racist. I’m raising doubts, as does Dr. Singleton, that the medical establishment itself has inbuilt racism, and it is that which not only leads to inequities among physicians, but also harms healthcare for minorities.
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Singleton, from her Linked In page:
h/t: Tm