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I Treated Thousands of Minority Patients. ‘Implicit Bias’ Training Is Dangerous.

June 26, 2023

The following op-ed was originally published at The Orange Country Register.

For more than two decades, I treated scores of indigenous patients—with the help of hundreds of indigenous healthcare workers—on the Navajo and Hopi reservations of Northern Arizona. So when I watched a mandatory “training” video for doctors on “understanding” Navajo patients make sweeping, inaccurate assumptions about Native Americans, here’s the thought that sprang into my mind:

This is dangerous.

One of the false “lessons” the “implicit bias” video taught: Native Americans supposedly approach health and disease in a manner far different from the mainstream scientific consensus. Past transgressions by white society, it went on, have caused indigenous people to distrust the medical system.

While such generalized statements may apply to some patients, they certainly don’t apply to all—because every patient is a unique individual. After five decades total as a surgeon whose patients came from a wide array of economic classes, educational levels, races, and ethnicities, I can say this with certainty: the current trend of implicit bias training in healthcare is personally insulting, potentially dangerous to our patients’ health, and ultimately counterproductive.

I had to watch these “implicit bias” training videos as a condition of faculty employment at a well-respected, academic healthcare center in Phoenix. But when it comes to mandatory trainings, meant to “help” so-called privileged groups recognize their unconscious biases by lecturing them about their ingrained racism, I’m not alone. Increasingly, medical professionals around the country are being presented with an ultimatum. As one registered nurse fired for refusing to comply wrote in The Wall Street Journal: “Falsely admit to being racist or abandon the medical field.”

The most sweeping of the “implicit bias” training mandates, and a possible harbinger of future state-wide edicts in other states? That would be in California, where according to the very letter of the law, “all continuing medical education courses”—which physicians need to complete to have their licenses renewed—must “contain curriculum that includes the understanding of implicit bias.”

But indoctrination programs that anger, demean, and insult people are unlikely to persuade them. Objective data demonstrating benefits in medical outcomes resulting from intrinsic bias training is inconsistent and sparse. Even those who believe racism is the source of disparate medical outcomes and support implicit bias training urge some caution using the current approach because of methodological problems.

While I recognize that social injustices exist, I remain unconvinced that racism is a major cause of outcome disparities—and I’m concerned that this indoctrination causes more harm than good. In fact, the evidence already suggests that this divisive ideology, rooted in racial discrimination, is being prioritized over the findings of scientific research to the detriment of patient health. A University of Illinois – Chicago researcher, for instance, effectively claimed the very concept of obesity is based in racism and encouraged doctors not to prescribe weight loss for obese patients.

I was born into an immigrant family, and I love this country that welcomed us and so many other families from around the world. America’s unique greatness is largely a product of its multi-ethnic, multi-cultural, and multi-racial population. I believe in the value of a melting pot, in the concept of e Pluribus Unum, and in the assimilation of citizens of all different backgrounds into a society that shares the ideal that every citizen has an equal right to liberty and justice under a rule of law outlined in the Constitution.

Our nation has never fully lived up to that ideal: the stain of slavery blemished the American project from beginning. Our treatment of indigenous populations was frequently barbaric. Yet the laws and institutions that were responsible for carrying out those reprehensible policies have largely been rescinded and abolished. Yes, a stain from our past dishonor does persist, but it is gradually fading.

We all discriminate in our private lives. We tend to prefer neighborhoods that cater to our socioeconomic preferences and marry spouses who share our cultural values, religion, and race. That doesn’t make us bigots—it reflects human nature. How would we react if bureaucrats tried to make our neighborhoods and marriages more inclusive by subjecting us to intrinsic bias training?

Cultures and ideas evolve in response to the realities of everyday living. The arts and entertainment are far more effective in changing people’s attitudes than mandatory indoctrination. More and more people are marrying spouses from different religious, ethnic, and racial backgrounds. Our children are increasingly taking on the beautiful hues of the melting pot. This is a bottom-up change that will take place over time.

Today, the overwhelming majority of Americans are the furthest thing from racist. But I worry that the kind of implicit bias training promulgated by so-called “diversity, equity, and inclusion bureaucracies” are playing into the hands of the small minority of bigots who can be found on both extremes of the political spectrum.

These trainings are only adding fuel to a fire that, if left alone, would eventually sputter out on its own.

Dr. Murray Feldstein is a visiting fellow at the Goldwater Institute. He has practiced as a surgeon for more than 50 years. 



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