Implicit bias training offers an opportunity to enhance patient care

By Ernie Yoder, MD, PhD, MACP

I read with interest a recent commentary of Dr. Daniel Dessner in the Detroit News, “Why it’s dangerous for Michigan to assume I’m biased against my patients”. Dr. Dessner expressed concerns regarding the State of Michigan requirement that all physicians licensed in Michigan complete implicit bias training on a regular basis – during each licensing cycle.

The State of Michigan defines implicit bias as “an attitude or internalized stereotype that affects an individual’s perception, action or decision making in an unconscious manner and often contributes to unequal treatment.” One definition of implicit is “implied though not plainly expressed.” Implicit bias is equivalent to unconscious bias. If a bias has been subtly inculcated, and thus unconscious, how can one know that they are unbiased…behaving in an unbiased fashion?

I, my colleagues, and all resident physicians at Authority Health are engaged in a program to improve our ability to relate to others who are members of another “group.” We do this work because, as physicians, we wish to assure development of effective, professional physician-patient relationships. Two years after initiating this program, we have become more comfortable discussing issues of race, ethnicity, LGBTQ, and gender differences, though not without challenging conversations and at times emotion. One component of this program is implicit/unconscious bias. The feedback from our residents has been profoundly positive, citing increased self-awareness and improved ability to discuss medical and social issues with each-other and our patients.

We entered into this program – created in partnership with New Detroit — with some trepidation.

Why didn’t we start this sooner? What other areas are there to explore? We wanted to become more caring, compassionate, and effective physicians. It may be intrusive and inconvenient to meet the state’s requirement, but it appears that this is a worthy endeavor.

I would be remiss if I did not mention that most medical schools are planning or have implemented similar programs. Most professional organizations (AMA, MSMS, AAMC, AACOM, etc.) already provide programs on reducing bias and improving diversity and inclusion. I believe this bodes well for the future of medicine and its practitioners. I view this as an opportunity to more effectively meet our patients where they are rather than a judgment by the state upon my personal attitudes, performance or values. Our faculty and residents (in family medicine, internal medicine, pediatrics, and psychiatry) all strive to facilitate excellent care, safety, and a positive experience for our patients. I believe training in implicit/unconscious bias will facilitate our success.

Dr. Yoder is director of Medical Education/Designated Institutional Officer at Authority Health.