Nurses and doctors don’t suffer from ‘implicit bias’ Making the problem worse

Fifty-five years ago, I took an oath to “Do No Harm.” This promise is at the heart of the medical profession that I love, and having worked alongside thousands of physicians and nurses and taught thousands of medical students, I’m continually inspired by my colleagues’ moral leadership.

In fact, I’ve always thought it puts medicine at the forefront of society’s fight against racism, since our oath inherently demands equal treatment for all. But, apparently, some of our state’s lawmakers think differently. They seem to believe that medicine is rife with racism and that we need new training to stamp it out.

Insulting requirement

Earlier this month, 12 members of the House of Representatives introduced a bill that would force every doctor, nurse, and health- care worker to take “implicit bias training” before receiving their license. This mandate is grounded in the idea that racism is prevalent in health care.

Many doctors and nurses have documented how such trainings accusing medical professionals of everything from “white supremacy” to “modern-day lynchings in the workplace.” The overarching point of this training is that medical professionals are, unwittingly or not, hurting the health of minority patients.

It’s true that minority communities often have worse health outcomes, but it’s false to attribute that to the prejudices of medical professionals. There are a huge number of factors at play, many tied to historical discrimination, from the cost of medical care to distance from providers to distrust in the medical system.

Accusing medical professionals of racism won’t address these realities. But it does insult the people who work tirelessly to treat every patient with the dignity and respect they deserve.

Does implicit bias exist?

No one has been able to pin down what, exactly, implicit bias is — not even the psychologists who’ve spent decades trying to do so.

The most common gauge of implicit bias is the Implicit Association Test, but a study in the Journal of Personality and Social Psychology found that the test leads to different outcomes when the same person takes it multiple times. That makes the test scientifically unreliable — a big problem when you’re trying to measure something and then train people to fight it.

Scholars have also shown, in the journal American Psychologist, that implicit bias accounts for as little as 2% of prejudicial behavior. Two of the Implicit Association Test’s own creators, Anthony Greenwald and Mahzarin Banaji, wrote in 2015 that it can’t accurately predict behavior.

If we don’t know how prevalent implicit bias is, or how it affects behavior, how will mandatory training on the topic be useful? Before forcing doctors and nurses to sit through this training, lawmakers should be sure it’s both necessary and effective. On both counts, implicit bias training falls short.

But if this mandate goes through, I fear it will harm — not help — the medical profession. Burnout is already a major problem among healthcare workers, and accusing them of bias and racism will only make it worse. The training may even worsen health outcomes for the very minority patients it’s supposed to benefit. It sends a message that racism is rampant in medicine. When you tell people that doctors struggle with bias and racism, you don’t exactly give them a reason to come to the doctor’s office.

Many people already delay treatment for a variety of reasons. We shouldn’t give them another reason — especially one that isn’t real.

Pennsylvania’s leaders should avoid this implicit bias training bill like the plague. Medical professionals already take an oath to “do no harm.” We work tirelessly to treat patients equally, because we’ve committed our lives to giving every patient the best possible treatment.

We’ll continue to uphold our oath and treat all patients equally — because that’s what we’ve been trained to do.