We’re Doctors. Implicit Bias Training Has No Place in Medicine.

by Martin Caplan, MD, and Kenneth Lipstock, MD

Apparently, Virginia’s doctors and nurses are racist.

This is the message of two bills that are moving through the state legislature. The bills would force medical professionals to take ongoing “implicit bias training” to get and keep their license. The problem is that such training is insulting, dangerous, and scientifically indefensible. It’s grounded in the false idea that people mistreat and even oppress others, especially those of a different race.

It’s a popular narrative, but there is no sound evidence to support it. What is clear is that if our lawmakers pass these bills, they’ll encourage racial division and tribalism, while undermining the medical profession and hurting patients who need our help.

To be clear, we both believe that prejudice exists and is utterly unacceptable. Before we became doctors, there were blacks-only hospitals in our state. We’ve come a long way since those days, and wherever racism still exists, we need to eliminate it. People deserve to be treated as unique individuals, not as members of a particular group.

But implicit bias training will not eliminate prejudice, because it assumes that prejudice cannot be eliminated. The whole point of implicit bias is that it’s unconscious and engrained. There’s nothing you can do about it. You simply need to be constantly told you are racist and forced to confess your sins.

Hence what the Virginia legislature is pushing—endless re-education programs every few years. The medical advocacy group Do No Harm has shown that such training is rife with radicalism and falsehoods. As white men, the two of us should prepare for accusations that we contribute to “modern-day lynchings” and practice “white supremacy.” In fact, we practice medicine, helping thousands of patients—white, black, brown, you name it—based on their individual medical needs.

Besides, is implicit bias even real? The evidence is clear: no.

This concept arose in the 1990s, in conjunction with a psychological tool known as the “Implicit Association Test.” The test tries to determine your racial bias by seeing how quickly you associate “good” and “bad” words with white and black faces. If you’re too slow with black faces or associate better words with white faces, that apparently indicates bias. The test is a  fixture in implicit-bias training and leads to eye-popping claims that the vast majority of society is racist.

But the test suffers from major problems. Psychologists have since found that people who retake the test rarely get anywhere close to the same results—the most important measure of whether a test is accurate. If a test is going to tell someone that they’re racist, it better be accurate.

Research has also shown that the test doesn’t accurately determine who will commit racist acts. At most, according to scholars, it can predict between 2 and 5.6% of prejudiced actions. Such findings have led some of the test’s most prominent backers to admit that it can’t predict behavior because it leads to “undesirably high rates of erroneous classifications.” In other words, the test is useless.

These facts put what the legislature is trying to do in a new light. Why do doctors and nurses need implicit bias training that’s not based on sound science and can’t determine who will commit racist acts?

Worst of all, far from fighting racism, this training encourages the very racial division it purports to fight. It treats medical professionals differently based on their skin color. It may even cause patients to wonder if their doctor or nurse is going to hurt them. If a test accuses white doctors of bias, why would black patients want to see them? The doctor-patient relationship is built on trust, but the idea of implicit bias sows distrust. People will see each other through a racial lens, assuming the worst about others, instead of working together to improve health.

The truth is that doctors and nurses fight for their patients, regardless of who they are, what they look like, or where they came from. That’s why we take an oath to “do no harm.” We’ve always strived to uphold that oath. So has every medical professional we’ve worked with over decades of practice. But there will be harm if the state legislature moves forward with this implicit bias training mandate.

Martin Caplan, M.D., is a cardiologist. Kenneth Lipstock, M.D., is an ophthalmologist. They both live in Richmond.